Temporal lobectomy for intractable epilepsy in patients over age 45 years

McLachlan, Richard S.; Chovaz, Cathy J.; Blume, Warren T.; Girvin, John P.

doi:10.1212/wnl.42.3.662

Cited by 53 publications

(47 citation statements)

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“…MacLachan et al 5 and Cascino et al 6 reported little to no postoperative change in IQ and memory in their older epilepsy patients. This is in agreement with previous reports.…”

Section: Discussionmentioning

confidence: 95%

Temporal lobectomy outcome in older versus younger adults

et al. 2000

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A total of 340 patients age 50 years and older were compared with 30 patients younger than 50 years, all of whom had anterior temporal lobectomy for refractory epilepsy. Seizure outcome, neuropsychological test scores, and change in driving status were analyzed. Age and duration of epilepsy were related independently to outcome, but laterality of interictal sharp waves (an early epilepsy risk factor) and presence of tumor were not. Sixteen patients (52%) in the older group and 257 patients (75.6%) in the younger group (p < 0.008) were seizure free. Postoperative neuropsychological outcome and driving status were similar in older and younger patients.

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“…MacLachan et al 5 and Cascino et al 6 reported little to no postoperative change in IQ and memory in their older epilepsy patients. This is in agreement with previous reports.…”

Section: Discussionmentioning

confidence: 95%

Temporal lobectomy outcome in older versus younger adults

et al. 2000

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“…34 A meticulous analyses of 126 studies published between 1991 and 2000 showed that a median of 70% of patients became seizure-free (range 33% to 93%), suggesting an improvement in the outcome in more recent studies. 35 Furthermore, selected patient populationssuch as patients with hippocampal sclerosis, 36 37 patients with complex febrile seizures, 38 or patients with foreign tissue lesions 39 40 -have significantly higher success rates, with 80-94% of patients becoming seizure-free.…”

Section: Discussionmentioning

confidence: 99%

Long term outcome of temporal lobe epilepsy surgery: analyses of 140 consecutive patients

Jutila

2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

120

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Objective: To analyse the long term results of temporal lobe epilepsy surgery in a national epilepsy surgery centre for adults, and to evaluate preoperative factors predicting a good postoperative outcome on long term follow up. Methods: Longitudinal follow up of 140 consecutive adult patients operated on for drug resistant temporal lobe epilepsy. Results: 46% of patients with unilateral temporal lobe epilepsy became seizure-free, 10% had only postoperative auras, and 15% had rare seizures on follow up for (mean (SD)) 5.4 (2.6) years, range 0.25 to 10.5 years. The best outcome was after introduction of a standardised magnetic resonance (MR) imaging protocol : in unilateral temporal lobe epilepsy, 52% of patients became seizure-free, 7% had only postoperative auras, and 17% had rare seizures (median follow up 3.8 years, range 0.25 to 6.5 years); in palliative cases (incomplete removal of focus), a reduction in seizures of at least 80% was achieved in 71% of cases (median follow up 3.1 years, range 1.1 to 6.8 years). Most seizure relapses (86%) occurred within one year of the operation, and outcome at one year did not differ from the long term outcome. Unilateral hippocampal atrophy with or without temporal cortical atrophy on qualitative MR imaging (p < 0.001, odds ratio (OR) 5.2, 95% confidence interval (CI) 2.0 to 13.7), other unitemporal structural lesions on qualitative MR imaging (p < 0.001, OR 6.9, 95% CI 2.2 to 21.5), onset of epilepsy before the age of five years (p < 0.05, OR 2.9, 95% CI 1.2 to 7.2), and focal seizures with ictal impairment of consciousness and focal ictal EEG as a predominant seizure type (p < 0.05, OR 3.4, 95% CI 1.2 to 9.1) predicted Engel I-II outcome. Hippocampal volume reduction of at least 1 SD from the mean of controls on the side of the seizure onset (p < 0.05, OR 3.1, 95% CI 1.1 to 9.2) also predicted Engel I-II outcome. Conclusions: Outcome at one year postoperatively is highly predictive of long term outcome after temporal lobe epilepsy surgery. Unitemporal MR imaging abnormalities, early onset of epilepsy, and seizure type predominance are factors associated with good postoperative outcome.

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“…In addition, there was no comparison with a younger population in some studies and the duration of follow-up after surgery was variable. McLachlan et al .,[62] compared seizure outcome 5 years after temporal lobectomy in 20 patients older than 45 years with that in 68 patients who were younger. The oldest patient was 60-years-old.…”

Section: Epidemiologymentioning

confidence: 99%

Epilepsy in the elderly: Special considerations and challenges

Acharya

2014

Ann Indian Acad Neurol

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The elderly are generally defined as those over 60 or 65 years old, but they are a heterogeneous group and may be subdivided into categories based on age and health status. The incidence of epilepsy is highest in the elderly. With a progressive increase in life expectancy, this is the fastest growing segment of patients with epilepsy. Older patients most often have focal seizures, with less prominent auras and automatisms, and longer duration of postictal confusion compared to younger patients. Status epilepticus is common and has a high mortality. The most common specific etiology is cerebrovascular disease, but the cause remains unknown in many patients. Diagnosis can be challenging because of several patient-related, physician-related and investigation-related factors. Over-diagnosis and under-diagnosis are common. Treatment is complicated by the presence of physiological changes related to aging, co-morbidities and cognitive problems as well as concerns regarding drug interactions and medication adherence. Seizures can be controlled in most patients with low doses of a single anti-epileptic drug (AED). Tolerability is an important factor in selection of an AED, as elderly patients tend to be highly sensitive to side effects. Drug-resistant epilepsy is uncommon. Epilepsy surgery, especially temporal lobectomy, can be performed in older patients with good results. More studies addressing the pathophysiological mechanisms of epilepsy in this age group, and greater inclusion of the elderly in clinical trials, as well as development of comprehensive care models are needed to provide optimal care to these patients.

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Temporal lobectomy for intractable epilepsy in patients over age 45 years

Cited by 53 publications

References 0 publications

Temporal lobectomy outcome in older versus younger adults

Temporal lobectomy outcome in older versus younger adults

Long term outcome of temporal lobe epilepsy surgery: analyses of 140 consecutive patients

Epilepsy in the elderly: Special considerations and challenges

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