gms | German Medical Science

Data about epilepsy surgery in elderly patients especially with extratemporal epilepsy are rare. This study, was therefore aimed at evaluating the results of epilepsy surgery in elderly patients with temporal and extratemporal epilepsies.

Twenty patients (8 females, 12 males; mean age: 55,7, minimum: 50, maximum: 68) were included in this study with a mean follow-up of 47 (5-106) months. Fourteen patients with temporal lobe epilepsy and 6 with extratemporal epilepsy were included. Temporal resection included the anterior and mesial temporal structures. Extratemporal resections were frontal in all 6 cases and individually tailored, based on the results of the diagnostic evaluation.

Seventeen patients (85%) were seizure free (class Ia, Engel 1993), one patient (5%) had an class II outcome and two patients (10%) were in outcome class III. All patients benefited from surgery. Outcome with regard to seizures was better in the temporal patients (Ia: 13=93%, III: 1=7%) than in the patients with frontal lobe epilepsies (Ia: 4=67%, II: 1=17%, III: 1=17%). Complications included a slight transient aphasia in one patient. Another patient had had a permanent mild ataxia and arm paresis secondary to an infarction in the territory of the superior cerebellar artery during angiography and amobarbital test. Six of the 14 temporal lobe epilepsy patients had hippocampal sclerosis, another 3 had tumours, 2 had dyplasias and 3 had other etiologies. The extratemporal etiologies were cavernomas (n=2), dysplasia (n=1) and 3 other etiologies.

The present study shows that epilepsy surgery in elder patients is associated with seizure outcome and morbidity comparable to younger adult epilepsy surgery candidates. Therefore, elder patients with pharmacoresistant temporal and extratemporal epilepsies should not be excluded from epilepsy surgery.