Abstracts

Rationale: A recent projection from the US census bureau reports of "an aging population" with expected doubling of population aged 65 and older over the next 30 years (https://www.census.gov/prod/2014pubs/p25-1140.pdf). It is well known that one of the highest prevalence of epilepsy among various age groups lies in patients over 60 years of age. Recent evidence is also pointing towards a nearly five-fold increase in new onset epilepsy over the last 4 decades among elderly patients, older than 65 years of age (JAMA Neurol. 2016;73(4):390-395). With a rapidly growing healthier and longer living population, it is merely a matter of time before we see more and more elderly patients with medically refractory epilepsy who may be potential candidates for resective epilepsy surgery (RES). In the light of these facts, we reported our experience with RES in septuagenarians (70 years or older) patients. Methods: After IRB approval, we searched our epilepsy surgery data base from 01/01/2000 to 06/30/2015 to find patients who underwent RES at or after 70 years of age and had at least 1 year postoperative follow up. We also calculated Charlson Combined Comorbidity Index scores and 10-year survival probabilities (using those scores) for each patient (J Clin Epidemiol 47:1245?"1251, 1994). We evaluated demographic, seizure variables as well as post-surgical pathology and RES outcomes for the patients. Results: We found seven patients who underwent RES at age of 70 years or older. There were four women. The age of epilepsy onset ranged from 24 ?" 71 years with monthly frequency of 4.2 (1-12) seizures. The mean Charlson Combined Comorbidity Index scores 4 (3-6). This translated into 10-year mean survival probabilities (using those scores) of 53% (2%-77%). Four patients (57%) had history of significant injuries due to seizures. All patients except one (85.7%) had positive MRI (Table 2). All patients underwent anterior temporal lobectomy, four on the left side. One patient had undergone two RES in his 70s, with the first one being a right temporal neocortical resection at the age of 72 years and the second one, resection of left remnants of mesial temporal structures at age of 75 years after a bilateral subdural grid evaluation (Table 1, Patient 1; showed the details of second RES provided). None otherwise underwent an invasive EEG evaluation. None of the patients suffered a surgical complication that resulted in long-term morbidity. From seven patients underwent RES at age range of 70-77 years, four patients achieved an Engle I outcome at the last follow-up. One patient had passed away during follow-up, eleven years after his second RES (Table 1). Conclusions: Our results show, for the first time in literature, that resective epilepsy surgery is a potential therapeutic option in septuagenarians with medically refractory focal epilepsy. The majority of our patients achieved an Engle I outcome without major surgical complications and despite wide scale of co-morbidities, a careful patient selection should remain the key factor in offering RES in this age group. Injuries related to seizures may be a possible motivational incentive to offer RES at this age rather than surgery withhold for perceived higher preoperative morbidity index. Large multi-center collaborative research study may help examining the possibility of maximizing the RES utilization in such a rapidly growing population group. Funding: None