gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Evaluation of success and risk in surgery for temporal lobe epilepsy in older patients

Evaluation von Erfolg und Risiko bei der chirurgischen Behandlung älterer Patienten mit Temporallappenepilepsie

Meeting Abstract

  • corresponding author Hans Clusmann - Neurochirurgische und Epileptologische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105 Bonn
  • A. Grivas - Neurochirurgische und Epileptologische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105 Bonn
  • T. Kral - Neurochirurgische und Epileptologische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105 Bonn
  • C. Helmstaedter - Neurochirurgische und Epileptologische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105 Bonn
  • J. Schramm - Neurochirurgische und Epileptologische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105 Bonn

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.08.06

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0085.shtml

Veröffentlicht: 23. April 2004

© 2004 Clusmann et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective

Only recently has epilepsy surgery been considered for patients older than 50 years of age. It is unclear however, whether clinical variables, success rates and surgical risks differ from typical younger collectives.

Methods

Fifty-two patients, older than 50 years of age, underwent surgery for refractory mesial temporal lobe epilepsy (TLE), and were retrospectively analysed. The mean age was 55 years, the mean duration of epilepsy 33 years. Surgical procedures were 40 amygdalohippocampectomies (33 ammonshornsclerosis, 7 other lesions), 7 anterior temporal lobectomies, and 5 lesionectomies plus hippocampectomy. Post-operative neuropsychological data was available for 34 patients. The follow-up was 32 (12-84) months.

Results

Satisfactory seizure control was obtained in 90,4% (47 patients, Engel Class I,II), seizure outcome was not satisfactory in the remaining 9,6% (5 patients, Engel Class III,IV). All patients with a seizure history of less than 30 years, or with a frequency of less than 5 seizures per months, had satisfactory control of their epilepsies. There was no mortality, surgical risks comprised one pulmonary embolism, and two postoperative hematomas, which had to be evacuated. Temporary neurological morbidity was seen in 15.4% (3 mild hemiparesis, 3 dysphasia, 3 diplopia). Permanent deficits (5.7%) were present in 2 patients with dysphasia and one with a mild hemiparesis. Post-operative exams of neuropsychological features showed stable results in approximately 50%, deteriorations in 25-30% and 20-30% of patients improved after surgery.

Conclusions

High rates of seizure control can be achieved in older people operated for TLE. The neuropsychological baseline was lower than in younger patients, but postoperative changes were not significantly different. As expected, although not statistically significant, complication rates seem to be somewhat higher in the older population, however the rate of permanent deficits was acceptable and there was no mortality in this series.