Abstracts

RATIONALE: Focal excisional surgery for non-lesional complex partial epilepsy is a highly successful method for controlling seizures, but is performed relatively infrequently in older patients due to concerns that surgery carries greater risks and diminished benefits for older patients compared to younger patients. We reviewed our surgical experience with older patients, to determine if these concerns were valid. METHODS: We evaluated the long-term seizure outcome after focal excisional surgery in 12 patients with non-lesional medically refractory complex partial seizures who were 45 years-old or older at the time of surgery. The duration of epilepsy before surgery ranged from 3-45 years (median 21 yr.) and age at surgery ranged from 45 to 60 years (median 50 yr). Preoperatively, patients had been using an average of 5.5 antiepileptic drugs (range 3-7). After a complete evaluation (including intracranial electrode monitoring in 4 patients), 11 patients underwent anterior temporal lobectomy (6 left, 5 right) including a two-stage procedure in two patients, and one underwent a frontal neocortical resection. Follow-up ranged from 2 7.5 years. Seizure outcome, number of AEDs at last follow-up, and any complications of surgery were reported. RESULTS:_ At the time of last follow-up, 10 patients were seizure-free, and 2 had > 90% reduction in seizure frequency. No patient was worse folowing surgery. Nine patients required only one antiepileptic drug, two others were using 2 drugs, and one was using 3 drugs. There were no deaths or significant permanent complications of surgery. CONCLUSIONS: Focal excisional surgery for non-lesional epilepsy can be performed in older patients, and can achieve seizure control rates that are comparable to those observed in younger patients. The need for a second surgical procedure in two patients suggests that anterior temporal lobectomy may be preferable to selective resections in older patients, perhaps due to the long-standing nature of their epilepsy. In older patients the long-term benefits of surgery may primarily relate to reduction in AED requirements and subsequent health impact as these patients enter the seventh decade of life or beyond.