Abstracts

Rationale: Despite its potential to offer seizure freedom, resective epilepsy surgery (RES) is seldom performed in patients >= 60 years of age. Older age may deter referrals to comprehensive epilepsy centers given concern of increased surgical risk due to age and related comorbidities. Quality of life after surgery in the older population has not been robustly explored. Demonstrating increased QOL and low surgical complication rates has the potential to increase referrals for this patient population. Accordingly, we evaluated outcomes and QOL in patients >= 60 years who underwent RES at our institution.Methods: All patients who underwent RES at UCLA for medically refractory focal onset seizures >= 60 years between 1992-2012 and had a minimum follow-up of 12 months were included. Comorbidities at the time of surgery (including hypertension, hyperlipidemia, diabetes mellitus, hypothyroidism, osteoporosis, obstructive sleep apnea, and dementia) were abstracted from the electronic medical record. A modified Liverpool life satisfaction tool was administered postoperatively, with a maximum score of 40. Parameters included: satisfaction with surgery, life changes in the spheres of health, driving, working, post surgical adjustment issues, and patient s perception of general health. Postoperative outcomes were determined via telephonic interviews and review of the patient s electronic medical records. Outcomes were classified according to the modified Engel classification system. Engel classifications of I and II were considered good outcomes.Results: A total of 10 patients aged >= 60 underwent RES during the study period. The mean age at the time of RES was 65.4+/-4.4 years (range 60-74 years). The mean duration of epilepsy prior to surgery was 27.8+/-13.1 years (range 3-48 years). At the time of surgery, the majority of patients (7/10, 70%) had at least 1 medical comorbidity in addition to refractory seizures. No patients experienced any postsurgical complications. The patients were followed for a mean of 3.2+/-2.3 years (range 1-7.5 years). At the time of final follow up, 9/10 patients (90%) were documented as having a good postsurgical outcome. Half (5/10) were completely seizure free (Engel classification Ia). QOL data was available for 9 patients. Following surgery, the mean modified Liverpool life satisfaction score was 30.4+/-8.3 (range 15-40). Of the 9 patients with additional life satisfaction data, 6 (75%) noted excellent satisfaction with their RES, with 3 (37.5%) noting postoperative improvements in their overall health.Conclusions: RES is safe and effective in patients >= 60 years of age. Ninety percent of patients in our cohort had a good surgical outcome, with 50% becoming completely seizure free. No patients had postoperative complications despite the majority having at least one medical comorbidity at the time of RES. Our data demonstrates that referral to a comprehensive epilepsy center for RES workup should not be negatively influenced by advancing age. This is particularly true given that such surgeries have the potential to improve overall health and QOL with advancing age.