Conference Coverage
HOUSTON—Elderly patients with refractory epilepsy may achieve a positive surgical outcome from resective epilepsy surgery, according to research presented at the 70th Annual Meeting of the American Epilepsy Society.
Ahmed Abdelkader, MD
The findings “were a surprise to us,” said Ahmed Abdelkader, MD, a research fellow at University Hospitals Case Medical Center in Cleveland. “We expected that [the rate of] complications would be higher, because this is a vulnerable age group with multiple comorbidities.”
Cases of new-onset epilepsy have increased nearly fivefold during the past 40 years in patients ages 65 and older. “With a rapidly growing, healthier, and longer living population, it is a matter of time before we see more and more elderly patients with medically refractory epilepsy who may be potential candidates for resective epilepsy surgery,” said Dr. Abdelkader.
Dr. Abdelkader and colleagues used the Cleveland Clinic Epilepsy Center database to identify patients ages 70 and older who underwent resective epilepsy surgery between January 1, 2000, and September 30, 2015. They limited the analysis to seven patients who had at least one year of postsurgical follow-up. The mean age of the patients at surgery was 73, and the age at epilepsy onset ranged from 24 to 71, with a monthly frequency of 4.2 seizures. The mean Charlson Combined Comorbidity Index score was 4, which translated into a 10-year mean survival probability of 53%.
Four patients (57%) had a history of significant injuries due to seizures. All but one patient, however, had a positive MRI. Three patients had hippocampal sclerosis, “which is unique, because most cases of hippocampal sclerosis are in younger age groups,” said Dr. Abdelkader.
All patients underwent anterior temporal lobectomy, four on the left side. No surgical complications were reported. Six of the seven patients had a good surgical outcome, defined as a Class I or II on the Engel Epilepsy Surgery Outcome Scale. Four patients were completely free of seizures at one year of follow-up.
One of the patients underwent two resective epilepsy surgeries: the first at age 72 and the second at age 75. He died of natural causes 11 years after the first surgery; he was the only patient to pass away during the follow-up period.
Future multicenter collaborative studies should “prospectively study factors influencing resective epilepsy surgery recommendation and its outcome in this rapidly growing population,” said Dr. Abdelkader.
—Doug Brunk
Suggested Reading
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):945-951.