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Long-Term Outcomes After Epilepsy Surgery in Older Adults

May 23, 2018

As the US population ages, the incidence of epilepsy along with other comorbidities is increasing as well. For older adults with medically intractable epilepsy, age is typically seen as a limiting factor in relation to epilepsy surgery, with the risks from surgery seeming to outweigh the benefits.

Dr Johannes Lang (Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany) and coauthors decided to investigate the long-term outcomes for older adults who had epilepsy surgery. Specifically, surgery benefits for patients aged 50 to 59 years old were compared with patients aged 60 and older in terms of safety and efficacy.

Patients ≥ 50 years old with medically intractable epilepsy who underwent epilepsy surgery from 1990 to 2013 were selected from the database of a German epilepsy center. These patients received a standardized and detailed presurgical diagnostic evaluation. Follow-up included at least 4 scheduled visits with electroencephalogram, magnetic resonance imaging, and neuropsychological testing. The Engel outcome scale was used to assess outcome.

Seventy-nine patients (between ages 50 and 67) were followed-up with for a median of 4.7 years (2-16 years); 68% of patients were free of disabling seizures (Engel class I, ≥60 years: 75%) and 58% were seizure-free (Engel class IA, ≥60 years: 70%). Ninety percent of patients suffered from temporal lobe epilepsy (TLE), 9% from frontal lobe epilepsy (FLE), and one occipital lobe epilepsy (OLE).

After surgery, 9% discontinued or tapered epilepsy medication. Permanent surgical complications occurred in 10% of cases and transient neurological deficits were present in 11%. Older patients had a higher risk for postoperative hygroma (≥60 years, 15%; <60 years, 8%) and were more prone to postoperative memory deficits (≥60 years, 45%), especially after resection of the dominant temporal lobe. Verbal and figural memory testing did not differ significantly between the groups (Seizure. 2018;57:56-62).

Researchers noted that the results support the position that, in certain older patients, epilepsy surgery provides equal or ever higher success rates compared with younger patients. Older patients, though, may be at greater risk for postoperative hygroma and memory problems, especially if the dominant temporal lobe is resected.

—Amanda Del Signore

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