Artikel
Surgical, neuropsychological and quality of life outcomes after temporal lobe epilepsy surgery in elderly – what have we learned?
Chirurgische, neuropsychologische und Lebensqualität-Ergebnisse nach chirurgischer Behandlung von Temporallappenepilepsie bei älteren Patienten
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Autoren
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Daniel Delev
- Klinik für Neurochirurgie, RWTH Universität, Aachen, Deutschland
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Alexander Grote
- Klinik für Neurochirurgie, Evangelisches Krankenhaus Bethel, Bielefeld, Deutschland
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Ann-Christin von Ehr
- Medizinische Fakultät, Universität Bonn, Bonn, Deutschland
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Ulrike Gleißner
- Klinik für Epileptologie, Medizinische Fakultät, Universität Bonn, Bonn, Deutschland
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Hans Clusmann
- Klinik für Neurochirurgie, RWTH Universität, Aachen, Deutschland; Medical Faculty, University of Bonn, Bonn, Deutschland
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Marec von Lehe
- Medizinische Hochschule Brandenburg, Neurochirugie, Neuruppin, Deutschland; Universität Bonn, Medizinische Fakultät, Bonn, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Surgery for drug-resistant focal temporal lobe epilepsy (TLE) is safe and effective treatment option. Nevertheless, epilepsy surgery is still underutilized, especially in elderly population. The aim of the study was to evaluate the epileptological results, quality of life and neuropsychological outcome in elderly patients, who underwent resective surgery for drug-resistant temporal lobe epilepsy.
Methods: All patients were submitted to standardized presurgical assessment including clinical, neuroradiological, neuropsychological and EEG-data. Elderly were considered those patients, who were older than 50 years. Comprehensive data concerning long-term seizure outcome, postoperative health-related quality of life (HRQOL) and neuropsychological outcome were evaluated and presented.
Results: A total of 94 consequent elderly patients (age >50 years) were included in the study. The mean age at surgery was 56 years (50–71, +/+4.4). Temporo-mesial resections were performed in 85 patients (90%). Seizure outcome was available in all 94 patients with a mean follow-up of 62.9 months. A total of 57 (60.6%) were completely seizure free (ILAE 1). The overall morbidity was 10% including 5 surgical complications and 5 permanent neurological deficits. Complete pre- and postoperative neuropsychological data were available in 63 patients, showing stable postoperative performance without significant neuropsychological deterioration. Postoperative quality of life data were available in 75 patients, revealing significant increase of HRQOL in all domains. Subgroup analysis showed that complete seizure freedom (ILAE 1) was the strongest predictor for HRQOL improvement (p<0.001). Postoperative changes in verbal memory and attention were significantly positive correlated with improvements in overall HRQOL, social function and cognitive function domain (p<0.05).
Conclusion: Surgery for drug resistant temporal lobe epilepsy is feasible option for elderly patients as they show seizure free rates, comparable to those in the younger population. The low rate of permanent neurological deficits, stable neuropsychological results and relevant improvements in quality of life of the seizure-free patients, justify surgical resection in properly selected elderly patients.
