Outcome after resective epilepsy surgery in the elderly

View More View Less
  • 1 Departments of Epileptology and
  • | 2 Neurosurgery, University Hospital Bonn, Germany
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

OBJECTIVE

The objective of this study was to compare complications, seizures, and neuropsychological outcomes after resective epilepsy surgery in patients ≥ 60 years of age who underwent operations to younger and matched controls.

METHODS

Charts of 2243 patients were screened for operated patients in the authors’ center between 2000 and 2015. Patients with available postsurgical follow-up data who were operated on at the age of 60 years or older and matched (by gender, histopathology, and side of surgery) controls who were between 20 and 40 years of age at the time of surgery were included. Outcomes regarding postoperative seizure control were scored according to the Engel classification and group comparisons were performed by using chi-square statistics.

RESULTS

Data of 20 older patients were compared to those of 60 younger controls. Postoperative seizure control was favorable in the majority of the elderly patients (Engel classes I and II: 75% at 12 months, 65% at last follow-up), but the proportion of patients with favorable outcome tended to be larger in the control group (Engel classes I and II: 90% at 12 months, p = 0.092; 87% at last follow-up, p = 0.032, chi-square test). The surgical complication rate was higher in the elderly population (65% vs 27%, p = 0.002), but relevant persistent deficits occurred in 2 patients of each group only. Neuropsychological and behavioral assessments displayed considerable preoperative impairment and additional postoperative worsening, particularly of verbal skills, memory (p < 0.05), and mood in the elderly.

CONCLUSIONS

The overall favorable postsurgical outcome regarding seizure control and the moderate risk of disabling persistent neurological deficits in elderly patients supports the view that advanced age should not be a barrier per se for resective epilepsy surgery and underscores the importance of an adequate presurgical evaluation and of referral of elderly patients to presurgical assessment.

ABBREVIATIONS

CCI = Charlson Comorbidity Index; DDD = defined daily dose; DNET = dysembryoplastic neuroepithelial tumor; FCD = focal cortical dysplasia; sAHE = selective amygdalohippocampectomy; VEM = video-EEG monitoring.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1

    Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):10691077.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Sillanpää M, Gissler M, Schmidt D. Efforts in epilepsy prevention in the last 40 years: lessons from a large nationwide study. JAMA Neurol. 2016;73(4):390395.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Brodie MJ, Elder AT, Kwan P. Epilepsy in later life. Lancet Neurol. 2009;8(11):10191030.

  • 4

    Kotsopoulos IAW, van Merode T, Kessels FGH, et al. Systematic review and meta-analysis of incidence studies of epilepsy and unprovoked seizures. Epilepsia. 2002;43(11):14021409.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Baumgartner A, Rauer S, Hottenrott T, et al. Admission diagnoses of patients later diagnosed with autoimmune encephalitis. J Neurol. 2019;266(1):124132.

  • 6

    Shiek Ahmad B, Hill KD, O’Brien TJ, et al. Falls and fractures in patients chronically treated with antiepileptic drugs. Neurology. 2012;79(2):145151.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Souverein PC, Webb DJ, Weil JG, et al. Use of antiepileptic drugs and risk of fractures: case-control study among patients with epilepsy. Neurology. 2006;66(9):13181324.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Delev D, Taube J, Helmstaedter C, et al. Surgery for temporal lobe epilepsy in the elderly: improving quality of life despite cognitive impairment. Seizure. 2020;79:112119.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Gómez-Ibáñez A, Garcés-Sánchez M, Hampel KG, et al. Epilepsy surgery beyond 50 years: long-term seizure and cognitive outcomes. J Neurol Sci. 2020;414:116872.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Lang JD, Grell L, Hagge M, et al. Long-term outcome after epilepsy surgery in older adults. Seizure. 2018;57:5662.

  • 11

    Punia V, Abdelkader A, Busch RM, et al. Time to push the age limit: epilepsy surgery in patients 60 years or older. Epilepsia Open. 2018;3(1):7380.

  • 12

    d’ Orio P, Pelliccia V, Gozzo F, et al. Epilepsy surgery in patients older than 50 years: effectiveness, safety, and predictors of outcome. Seizure. 2017;50:6066.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Dewar S, Eliashiv D, Walshaw PD, et al. Safety, efficacy, and life satisfaction following epilepsy surgery in patients aged 60 years and older. J Neurosurg. 2016;124(4):945951.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Costello DJ, Shields DC, Cash SS, et al. Consideration of epilepsy surgery in adults should be independent of age. Clin Neurol Neurosurg. 2009;111(3):240245.

  • 15

    Acosta I, Vale F, Tatum WO IV, Benbadis SR. Epilepsy surgery after age 60. Epilepsy Behav. 2008;12(2):324325.

  • 16

    Grivas A, Schramm J, Kral T, et al. Surgical treatment for refractory temporal lobe epilepsy in the elderly: seizure outcome and neuropsychological sequels compared with a younger cohort. Epilepsia. 2006;47(8):13641372.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Sirven JI, Malamut BL, O’Connor MJ, Sperling MR. Temporal lobectomy outcome in older versus younger adults. Neurology. 2000;54(11):21662170.

  • 18

    Moura LMVR, Eskandar EN, Hassan M, et al. Anterior temporal lobectomy for older adults with mesial temporal sclerosis. Epilepsy Res. 2016;127:358365.

  • 19

    Engel J Jr, Van Ness P, Rasmussen TB, Ojemann LM. Outcome with respect to epileptic seizures. In: Engel J Jr, ed. Surgical Treatment of the Epilepsies.2nd ed. Raven Press;1993:609621.

    • Search Google Scholar
    • Export Citation
  • 20

    Grote A, Witt JA, Surges R, et al. A second chance—reoperation in patients with failed surgery for intractable epilepsy: long-term outcome, neuropsychology and complications. J Neurol Neurosurg Psychiatry. 2016;87(4):379385.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Clusmann H, Schramm J, Kral T, et al. Prognostic factors and outcome after different types of resection for temporal lobe epilepsy. J Neurosurg. 2002;97(5):11311141.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Beck A, Steer R. Beck Depression Inventory Manual. Psychological Corporation; 1987.

  • 23

    Cramer JA, Perrine K, Devinsky O, Meador K. A brief questionnaire to screen for quality of life in epilepsy: the QOLIE-10. Epilepsia. 1996;37(6):577582.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Glogau SJ. Validierung des “Fragebogens zur Persönlichkeit bei zerebralen Erkrankungen”. (FPZ) an einer Stichprobe von Epilepsiepatienten und Gesunden. Dissertation.Universität Bielefeld;2006.http://biesonubuni-bielefeldde/volltexte/2006/981/

    • Search Google Scholar
    • Export Citation
  • 25

    Hoppe C, Elger CE, Helmstaedter C. Long-term memory impairment in patients with focal epilepsy. Epilepsia. 2007;48(9)(suppl 9):2629.

  • 26

    Burneo JG, Black L, Martin R, et al. Race/ethnicity, sex, and socioeconomic status as predictors of outcome after surgery for temporal lobe epilepsy. Arch Neurol. 2006;63(8):11061110.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Burneo JG, Villanueva V, Knowlton RC, et al. Kaplan-Meier analysis on seizure outcome after epilepsy surgery: do gender and race influence it? Seizure. 2008;17(4):314319.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 623 623 91
Full Text Views 118 118 54
PDF Downloads 178 178 88
EPUB Downloads 0 0 0