Epilepsia, 48(3):564–570, 2007 Blackwell Publishing, Inc. C  2007 International League Against Epilepsy Postsurgical Health-related Quality of Life (HRQOL) in Children Following Hemispherectomy for Intractable Epilepsy ∗ †Stephanie Y. Griffiths, †Elisabeth M. S. Sherman, †Daniel J. Slick, ‡Kim Eyrl, §Mary B. Connolly, and ¶Paul Steinbok ∗ Department of Psychology, Simon Fraser University, Burnaby, British Columbia; †Department of Psychology, Alberta Children’s Hospital, Calgary, Alberta; ‡Department of Psychology, British Columbia Children’s Hospital, Vancouver, British Columbia; §Division of Neurology, British Columbia Children’s Hospital and University of British Columbia, Vancouver, British Columbia; and ¶ Division of Neurosurgery, Section of Surgery, British Columbia Children’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada Summary: Health-related quality of life (HRQOL) is an impor- tant outcome measure in clinical research. Given the psychoso- cial and behavioral difficulties associated with pediatric epilepsy, evaluating HRQOL in this patient population is of particular im- portance. Though HRQOL has been examined in pediatric pa- tients receiving focal resection or pharmacological (antiepileptic drug; AED) treatment, it has not been assessed in patients receiv- ing hemispherectomy (HE) for intractable epilepsy. The current study evaluated HRQOL in a sample of pediatric HE cases (N = 26) using previously validated questionnaires relative to sur- gical (N = 30) and nonsurgical (N = 84) comparison groups. Compared with focal resection and nonsurgical patients, parents of children who received HE reported similar levels of HRQOL. In surgical cases, worse HRQOL was correlated with residual seizure frequency. In both surgical and nonsurgical cases, fe- male gender, higher AED load, and lower functional indepen- dence predicted worse HRQOL. Interestingly, HE status (i.e., having undergone HE) predicted fewer epilepsy-related limita- tions. Consistent with previous findings, AED load, in addition to lower functional abilities, appear particularly detrimental to life quality in pediatric epilepsy. HE, however, is not associ- ated with increased risk for poor HRQOL. When considered in light of the multiple, significant risk factors for poor outcome associated with HE, children who undergo the procedure fare surprisingly well. Key Words: Health-related quality of life— Hemispherectomy—Postsurgical—Intractable epilepsy. Considerable research has addressed health-related quality of life (HRQOL) as an index of objective and subjective well-being in medical patients, and literature pertaining to HRQOL in chronic pediatric health condi- tions has been accumulating (McLaughlin and Bjornson, 1998). The elevated incidence of behavioral and adjust- ment problems in epilepsy relative to other chronic disor- ders of childhood and adolescence reported by some re- searchers (Oostrom et al., 2001), highlights the importance of considering the impact of this disorder on life quality. Developmental or preexisting familial stressors (Oostrom et al., 2001), as well as comorbid intellectual or neurologi- cal impairments and antiepileptic drug (AED) load (Sabaz et al., 2001; Miller et al., 2003) have been suggested as important determinants of HRQOL in pediatric epilepsy. In studies including comparisons with other chronic child- Accepted October 9, 2006. Address correspondence and reprint requests to Dr. Elisabeth M.S. Sherman, Neurosciences Program, Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, AB, Canada, T3B 6A8. E-mail: Elisabeth.Sherman@calgaryhealthregion.ca doi: 10.1111/j.1528-1167.2006.00966.x hood illnesses, pediatric epilepsy has been associated with significantly reduced HRQOL (Austin et al., 1994), even if seizures have been well controlled with AEDs (Austin et al., 1996). Surgical interventions are explicitly designed to im- prove HRQOL through reduction of seizure frequency. Consequently, HRQOL is a particularly pertinent out- come to measure in patients receiving epilepsy surgery. As Hermann (1994) points out, systematic exploration of HRQOL in patients who undergo surgical procedures to control their epilepsy may improve our understand- ing of the benefits and risks of these interventions. In- deed, consideration of psychological, social, and physical well-being has become increasingly important in pediatric epilepsy treatment and research, and should be evaluated in this population (Dean and Lannon, 2000). Evaluations of HRQOL following focal resection surgery in some samples of children with epilepsy have revealed mixed postsurgical adjustment, with patients tending to identify fewer barriers to HRQOL than their parents (Elliott et al., 2000). A review of the literature concluded that the typical pattern of substantial HRQOL 564