Lang JD, et al. - This study incorporated an analysis of the outcome after epilepsy surgery in older adults, by comparatively assessing the benefit for patients aged 50-59 years with those aged 60 years and older with regard to the efficacy and safety. Equal or even higher success rates were reported by epilepsy surgery in selected older patients compared to younger patients at similar risks. Nonetheless, subjects of older age were possibly found to be at a greater risk for postoperative memory deficits, particularly following dominant temporal lobe resections.

Methods

• Using database of a German epilepsy centre, experts selected subjects aged ≥50 years with medically intractable epilepsy who underwent epilepsy surgery from 1990 to 2013.
• A standardized and detailed presurgical diagnostic evaluation was performed on all patients.
• Follow-up consisted of at least four scheduled visits with EEG, MRI and neuropsychological testing.
• The Engel outcome scale was used to examine the outcome.

Results

• Herein, 79 patients aged between 50 and 67 years were followed-up for a median of 4.7 years (2-16 years).
• Findings illustrated that 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%).
• Temporal lobe epilepsy (TLE) was reported in 90% of the patients, 9% subjects suffered from frontal lobe epilepsy (FLE) and 1 from occipital lobe epilepsy (OLE).
• It was noted that 9% patients discontinued or tapered their medication after surgery.
• The occurrence of permanent surgical complications was found in 10% of cases and transient neurological deficits were observed in 11%.
• A higher risk for postoperative hygroma (≥60 years 15%; <60 years 8%) was discovered in older patients.
• These patients were also more prone to postoperative memory deficits (≥60 years 45%), particularly following resection of the dominant temporal lobe.
• No notable variation was disclosed in the verbal and figural memory testing between the groups.