Artikel
Age is not a limiting factor in older adults when considering resective temporal lobe epilepsy surgery
Das Alter spielt keine Rolle bei älteren Patienten mit resektiven epilepsiechirurgischen Eingriffen am Temporallappen
Suche in Medline nach
Autoren
Veröffentlicht: | 8. Mai 2019 |
---|
Gliederung
Text
Objective: Resective temporal lobe epilepsy surgery (RTLES) is well established as a method of treatment for patients with refractory temporal lobe epilepsy (rTLE). However, the majority of patients who underwent RTLES for rTLE are young adults. The number of older patients with newly diagnosed epilepsy is growing. Data reporting surgical outcomes from RTLES in older adults is scarce and age is often considered a limiting factor. The aim of the study was to report on RTLES for rTLE in patients aged 50 and older compared to younger candidates.
Methods: Patients with rTLE who underwent RTLES between 2012 and 2017 were reviewed from the epilepsy surgery database at our center. Inclusion criteria were age ≥18 at surgery and minimum completed 1-year follow-up (1y-FU) after RES. All patients were pre-surgically assessed in the department of epileptology and were considered to be suitable for surgery. The patients were divided into two groups according to age at time of surgery (group I: age 18–49; group II: age ≥ 50). The clinical features, seizure outcome and surgical complications were evaluated and compared between the two groups.
Results: Out of 184 patients who underwent RTLES in the study period, 144 patients met the inclusion criteria. 111 patients were aged 18–49 (group I), and 33 patients at age 50 and older (group II). The mean age at epilepsy onset (group I vs. group II: 16.95y±11.2 vs. 24.6y±16.3, p=0.008), the mean age at surgery (34y±8.9 vs. 56.58y±5.8, p=0.0001) and the duration of epilepsy (17.2y±11.09 vs. 31.97y±15.8, p=0.0001) differ significantly between the two groups. The post-op. seizure outcome at 1y-FU did not differ between younger and older patients (72% ILAE Class1 vs. 85% ILAE Class1, p=0.17). The surgical complications occurred in 18% in group II vs. 10% in group I, p=0.22. The permanent morbidity was 6% in group II vs. 2% in group I, p=0.22.
Conclusion: The results revealed that in selected older adults, RTLES leads to similar or even better post-operative seizure outcome as compared to younger candidates, despite the fact of later epilepsy onset and longer epilepsy duration. The rate of surgical complications and permanent morbidity did not differ between the two groups. Our findings show that when older adults are considered to be suitable for RTLES, age should not be the limiting factor in the decision making process.