Role of resective surgery in patients older than 60 years with therapy-resistant epilepsy

Juan S. Bottan MD1, Ana Suller Marti MD2, Jorge G. Burneo MD, MSPH, FRCPC2,3, Andrew G. Parrent MD, FRCSC2, Keith W. MacDougall MD, FRCSC2, Richard S. McLachlan MD, FRCPC2, Seyed Mirsattari MD, PhD, FRCPC2, David C. Diosy MD, FRCPC2, and David A. Steven MD, MPH, FRCSC2,3
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  • 1 Neurosurgery Section, Hospital Pedro de Elizalde, Buenos Aires, Argentina;
  • | 2 Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and
  • | 3 Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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OBJECTIVE

Epilepsy surgery for older adults is controversial owing to their longer duration of epilepsy and perceived higher surgical risk. However, because of an aging population and documented benefit of epilepsy surgery, surgery is considered more frequently for these patients. The authors’ objective was to analyze the role of resective surgery in patients older than 60 years and to assess outcomes and safety.

METHODS

The authors conducted a retrospective analysis of 595 patients who underwent resective epilepsy surgery at their center from 1999 to 2018. Thirty-one patients aged 60 years or older were identified. Sixty patients younger than 60 years were randomly selected as controls. Population characteristics, results of presurgical evaluations, outcomes, and complications were analyzed.

RESULTS

No significant differences were found between the groups in terms of hemisphere dominance, side of surgery, presence of a lesion, and incidence of temporal lobe epilepsy. Epilepsy duration was greater in the older cohort (p = 0.019), and invasive EEG was more commonly employed in younger patients (p = 0.030). The rates of Engel class I outcome at 6 months, 1 year, and 2 years were 89.7%, 96.2%, and 94.7% for the older group and 75% (p = 0.159), 67.3% (p = 0.004), and 75.8% (p = 0.130) for the younger group, respectively. The proportion of seizure-free patients was greatest among those with temporal lobe epilepsy, particularly in the older group. Neurological complication rates did not differ significantly between groups, however medical and other minor complications occurred more frequently in the older group.

CONCLUSIONS

Patients older than 60 years had equal or better outcomes at 1 year after epilepsy surgery than younger patients. A trend toward a greater proportion of patients with lesional temporal lobe epilepsy was found in the older group. These results suggest that good seizure outcomes can be obtained in older patients despite longer duration of epilepsy.

ABBREVIATIONS

ATL = anterior temporal lobectomy; HS = hippocampal sclerosis; SEEG = stereotactic electroencephalography; TLE = temporal lobe epilepsy; TRE = therapy-resistant epilepsy.

Images from Minchev et al. (pp 479–488).

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