gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Benefit and risk of epilepsy surgery in the elderly

Meeting Abstract

  • M. von Lehe - Neurochirurgie, Universitätsklinikum Bonn
  • A.C. von Ehr - Neurochirurgie, Universitätsklinikum Bonn
  • J. Wellmer - Epileptologie, Universitätsklinikum Bonn
  • H. Clusmann - Neurochirurgie, Universitätsklinikum Bonn

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMI.04-09

DOI: 10.3205/09dgnc191, URN: urn:nbn:de:0183-09dgnc1918

Veröffentlicht: 20. Mai 2009

© 2009 von Lehe 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 vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Surgical treatment of epilepsy in older patients is rarely described and there is some doubt about its efficacy. We analyzed our experience with respect to morbidity/mortality, seizure outcome and post-operative Quality of Live (QoL).

Methods: Between 1989 and July 2005 119 consecutive patients ≥ 50 years (mean 56, range 50– 73) were operated for refractory focal epilepsy. 104 patients (86%) had different kinds of temporal resections, 14 had frontal and one had an occipital resection. Seizure outcome data was available in 117 patients (98%; mean follow-up 61 months, range 18-228) and for self-assessed QoL in 85 patients (70%).

Results: According to the ILAE-classification (last available outcome, lao) 74 patients were seizure free (63%, ILAE 1). 4 patients continued to have auras (3%, ILAE 2), and 16 patients had up to 3 seizure days per year (14%, ILAE 3), resulting in 80% of patients with a satisfactory seizure outcome. Less favourable results were achieved in 20% of patients (N=21, ILAE 4: 4 seizure days per year to 50% reduction of the seizure frequency; N=2, ILAE 5: unchanged seizure frequency).

41 patients (34%) underwent invasive EEG-monitoring with implanted electrodes, 4 of them (10%) had local or systemic complications. After the resective procedure 13 patients (11%) had transient neurological deficits, 7 patients (6%) suffered from permanent neurological deficits. 5 patients had systemic (4%) and 6 local complications (5%). One patient died.

Overall QoL correlated strongly with satisfactory seizure outcome (p<0.001). With respect to four different domains of QoL, social situation and mood showed strongest dependency on seizure outcome (p<0.001 respectively; physical and cognitive functioning: p=0.01 and p=0.03, respectively).

Conclusions: Seizure outcome in the elderly is comparable to outcome results of younger patients. There is a substantial rate of morbidity and local or systemic complications in this group of patients. Taken together epilepsy surgery in older patients bears the chance of seizure control, but the risk of complications has to be considered.