July 18, 2018
For older adult patients considering epilepsy surgery, a new study published online in Epilepsy & Behavior suggests that age should not be a determining factor in the decision.
On average, a quarter of patients with newly diagnosed epilepsy are older adults. Due to clinical bias that they incur increased surgical risks, older adults with epilepsy are often less likely to be offered resective surgery.
A research team led by Rebecca O’Dwyer, MD, assistant professor at the Department of Neurological Sciences, Rush Medical College (Chicago, IL), and colleagues, conducted a retrospective study to understand epilepsy surgeries in patients 50 years or older. The study took place at a tertiary care center over a 15-year period with an average follow-up period of 6 years. Currently, there are few peer-reviewed case series that address this cohort and their outcomes.
For the study, the researchers observed patients with epilepsy who underwent surgery between 2001 and 2016. The inclusion criteria for the study included patients who were older than age 50 at surgery, availability of presurgical evaluation data, and minimum one year of follow-up data. The seizure outcome was evaluated using the Engel classification system.
Of 276 patients who underwent epilepsy surgery, the research team identified 34 patients aged 50 years or older. The average age of the patients at the time of surgery was 55 years, and average duration of epilepsy was 30 years.
Over the 6-year follow-up period, 22 out of the 34 patients (64%) were seizure free (Engel class I) at their final follow-up visit. Patients with lesional pathology on neuroimaging were also likely to be seizure free (P < .02). Additionally, the researchers identified parameters associated with poorer outcomes, which included extratemporal epileptogenic focus (P = .07) and bitemporal interictal epileptiform activity (P = .003).
“Our study cohort is one of the largest and most representative outcome studies of this age group, following the cohort for 6 years,” Dr O’Dwyer and colleagues commented in the study. “Our findings demonstrated that when considering epilepsy surgery in an older adult, their age should not play a determining role in the decision—a finding that is more common in modern literature.”
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