Abstracts

Older age at surgery is considered to carry higher surgical risk. There are few reports on surgical outcome in this age group. We report a series of 51 patients over 45 years of age who had surgery between 1992 and 2005 at UCLA. A prospective seizure outcome data collection was done., The inclusion criteria were intractable epilepsy, a minimum of 12 months follow-up, and patients 45 years and older at surgery. The last follow-up, done in 2006 for all patients included a computer assisted telephonic interview of the life fulfillment satisfaction scale (Liverpool QOL questionnaire). The following factors were considered: Satisfaction with surgery, life changes in the spheres of health, driving, working, adjustment issues, patients perception to general health and reasons for delay in obtaining surgery., The mean age of surgery in the series was 52 years (range 45-74). The mean follow up was 4.3 years (range 1-11 years.) Mean duration of epilepsy was 29.3 years (range 2-55 yrs). Most patients would have had surgery earlier but gave failure to refer and lack of knowledge about surgery as reasons for delay. The age of onset was divided into 3 groups those between 1-10 years (n=18), 11-20 years (n=12) and more than 21 years (n= 22). Forty patients (80%) had an Engel class I outcome. Four had an outcome of II, the rest had a poor outcome. Impact of nocturnal seizures only (n=3) (Engel class II) was high, contrary to expectations. The life fulfillment scores averaged 38 (range 16 to 49) out of a total of 52 and did not correlate to the patients perceived satisfaction with surgery and were lower for those patients with poor social recovery and multiple adjustment issues. There were 5 deaths in this group, only one of these was directly related to surgery and occurred 3 wks after surgery., Seizure outcome was excellent but poor social recovery and low life satisfaction scores were frequently recorded. Age should not limit access to surgery; however, the missed opportunity for psychosocial improvement, reducing the impact and promoting healthy aging and life satisfaction should prompt early surgery.,