Outcome of temporal lobectomy for hippocampal sclerosis in older patients

Abstract

Patients of 50 years or older account for a small but significant portion of the patient population that receives surgical treatment for epilepsy. There have been few studies reporting surgical outcomes from temporal lobectomy in older patients. We examined seizure outcome and surgical complications after anterior temporal lobectomy for temporal lobe epilepsy with pathological evidence of unilateral hippocampal sclerosis. Two patient groups were compared in this study: patients 50 years or older (mean age 55.5 years old, n=16) and patients less than 50 years old (mean age 32.9 years old, n=184). After a minimum of one year follow up, younger patients (79.4%, n=146) were significantly more likely to be seizure-free (p=0.041) compared to older patients (56.3%, n=9). There was no significant difference (p=0.404) between the two age groups in the percentage of patients withdrawn from medication following surgery. Surgical complications were significantly higher in the older age group compared to the younger age group (p=0.009), although there was no permanent morbidity. Thus, while surgical treatment of temporal lobe epilepsy with unilateral hippocampal sclerosis is still beneficial in older patients who are refractory to medical therapy, surgical treatment should be considered at as early an age as possible, to maximize the chance for a better outcome with fewer complications.

Laser ablation therapy: An alternative treatment for medically resistant mesial temporal lobe epilepsy after age 50

“…More selective approaches to temporal lobe epilepsy have been developed with the potential advantage of improving postoperative neuropsychological performance [16,25,26]. However, despite surgical advances, patients greater than 50 years of age usually have more comorbidities and may be at an increased risk of surgical complication [6,7]. Moreover, these patients may not even be candidates for an open surgical procedure.…”

“…e l s e v i e r . c o m / l o c a t e / y e b e h Previous reports have documented the safety and efficacy of temporal lobectomy for an older population [5,6]. However, concerns persist regarding the rate of surgical complications or associated comorbidities [6].…”

Safety, efficacy, and life satisfaction following epilepsy surgery in patients aged 60 years and older

“…1,12 Age ranges over 45 years include upper age limits > 60 years in only a small number of studies. 20,22 However, even including patients older than 60 years at the time of RES does not result in a significant reduction in the rate of postoperative seizure freedom or an increase in complication rates. 7,16,22 …”

Clinical predictors of 2-year outcome of resective epilepsy surgery in adults with refractory epilepsy: a cohort study

“…In individuals aged less than 50 years, 58% were allocated to Engel class I, while 74% of those who were aged more than 50 years and 91% of those who were aged more than 60 years were allocated to Engel class I 16. There were no differences in surgical outcome in terms of medication withdrawn between older and younger patients (threshold value=50 years), but more surgical complications in the older group 32. Previous studies in children or teenagers showed that early surgical treatment correlated with a better Engel class outcome 33 34.…”