Seizure and Cognitive Outcomes of Temporal Lobe Epilepsy Surgery in Patients Older Than 50 Years
Abstract number :
3.338
Submission category :
9. Surgery / 9C. All Ages
Year :
2022
Submission ID :
2205143
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:28 AM
Authors :
Sandra Wahby, MSc – University of Calgary; Lisa Partlo, PhD – Clinical Neurosciences – University of Calgary; Neelan Pillay, MD – Clinical Neurosciences – University of Calgary; Colin Josephson, MD, MSc – Clinical Neurosciences – University of Calgary; Paolo Federico, MD, PhD – Clinical Neurosciences – University of Calgary; Samuel Wiebe, MD, MSc – Clinical Neurosciences – University of Calgary; Walter Hader, MD, MSc – Clinical Neurosciences – University of Calgary
Rationale: To assess the seizure outcomes and cognitive risks of temporal lobe surgery in patients 50 years and older.
Methods: We performed a single centre retrospective study of adult patients treated with temporal resections including mesial structures between 2000 and 2020. We included patients who had at least one year surgical follow-up, and had undergone both a pre- and post-operative neuropsychological assessment and who had scores on the California Verbal Learning Test-II Long Delay Free Recall (CVLT-II LDFR), Rey Complex Figure Test Delayed Recall (RCFT DR), and Boston Naming Test (BNT) to assess verbal and visual learning and memory, and naming ability. In addition, depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II) at each neuropsychological assessment. Patients aged 50 years or older (older group) were compared to patients younger than 50 years (younger group) using univariable comparisons between groups on seizure outcome (Engel classification), neuropsychological test scores, and anti-seizure medication (ASMs) use and driving status.
Results: We identified 36 patients aged 50 years or older at time of surgery with a median age of 55 (IQR 53-59) and 42% were female. There were 101 patients younger than 50 years with a median age of 31 (IQR 27-39) and 46% were female. Older patients had a significantly longer duration of epilepsy before surgery (median 21, IQR 11-42 vs. 14, IQR 7-22; p=0.02) and had a longer length of hospital stay (median 5, IQR 4-7 vs. 4, IQR 3-5; p=0.002). There was no statistically significant difference between the older and younger group respectively on seizure outcome (Engel class I: 72% vs. 74% and Engel class II-IV: 28% vs. 26%), and driving status (Driving 42% vs. 47%) and use of ASMs at last follow-up (81% vs. 80%). The change score (post-op score – pre-op score) on the CVLT-II LDFR, RCFT DR, and BDI-II were comparable between the groups. However, the older group had a significant decline in naming ability (BNT) compared to the younger group (z-score change: -0.62 vs. -0.14; p=0.01).
Conclusions: Our findings indicate that surgery is a similarly effective treatment option for older patients with temporal lobe epilepsy for seizure control, although the cognitive (naming) risks of surgery appear greater for older patients.
Funding: None
Surgery