Abstracts

Elderly patients over account for about 25% of newly diagnosed epileptic seizures. Nevertheless, the proportion of older patients undergoing long term video-EEG monitoring is low and the percentage of epilepsy surgery in this particular subgroup is even lower. As a consequence, literature concerning the surgical treatment of focal epilepsies in elderly patients is sparse. In this study the data of 37 patients (31 with mesial temporal lobe epilepsy and 6 with extra-temporal epilepsy) who underwent epilepsy surgery after the age of 50 has retrospectively been evaluated for (a) medical and social issues at the time of surgery and (b) the outcome two years after operation. At the time of presurgical evaluation, the mean age was 55 (range: 50-67), mean duration of epilepsy was 34 (range: 1-59). Seventeen patients were still in employment, 11 were retired, 1 was unemployed, 7 were housewives. Seventeen patients (46%) had vascular risk factors, e.g. arterial hypertension, intra- and/or extracranial arteriosclerosis, hypercholesterolemia, one had COPD.
Seven patients (19%) had only minor predictable surgery-related deficits (e.g. discrete upper-square scotomas or moderate contralateral sensory deficits) that did not lead to significant impairment of daily activity, and 23 patients (62%) had no deficits at all. Four patients (11%) developed perioperative cerebral infarctions and two patients (5%) suffered major psychiatric alterations after the operation (one patient committed suicide).
Two years after surgery the data of 33 patients showed that 32 of these patients had benefited from the operation (Engel class I-III) and 42% (n=14/33) were seizure free (Engel class Ia+Ib). The number of seizure-free patients was higher after anterior temporal lobectomy (46%; n=13/28) compared to the extra-temporal group (20%; n=1/5). In the future, the increase in life expectancy and the resulting increase in numbers of patients suffering from refractory epilepsies will become a medical and economic challenge. Our study indicates that epilepsy surgery can benefit patients older than 50. However, due to the higher surgical risk, the risk-benefit ratio should be weighed carefully.