Epilepsy surgery for drug-resistant temporal lobe epilepsy in over-50 year-olds: Seizure outcome, surgical complications and neuropsychological outcome - 07/06/22

Doi : 10.1016/j.neuchi.2022.04.001

I. Mezjan ^a, H. Brissart ^b,^c, D. Masson ^a, J.-P. Vignal ^b, O. Aron ^b, M. Ferrand ^b, T. Civit ^a, L. Maillard ^b,^c, S. Colnat-Coulbois ^a,⁎
^a Department of Neurosurgery, University Hospital of Nancy, Lorraine University, Nancy, France
^b Epileptology Unit, Department of Neurology, University Hospital of Nancy, Lorraine University, Nancy, France
^c Neurosciences of Systems and Cognition Project, BioSiS Department (Département Biologie, Signaux et Systèmes en Cancérologie et Neurosciences), Nancy Research Center for Automatic Control (CRAN), Lorraine University, CNRS, UMR 7039, Vandoeuvre, France

^⁎Corresponding author. Service de Neurochirurgie, Hôpital Central – CHRU Nancy, 29, avenue du Maréchal de Lattre de Tassigny, 54000 Nancy, France.Service de Neurochirurgie, Hôpital Central – CHRU Nancy29, avenue du Maréchal de Lattre de TassignyNancy54000France

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Abstract

Objective

Surgery is an effective treatment for drug-resistant temporal-lobe epilepsy (TLE), but is still underutilized for older patients because of a perceived higher rate of perioperative complications, cognitive decline and worse seizure outcome.

Methods

We retrospectively screened all patients operated on in our institution for drug-resistant TLE between 2007 and 2019. Data of patients aged ≥50 years versus <50 years at surgery were compared. The primary endpoint was freedom from disabling seizure (Engel I) at 2 years postoperatively.

Results

In patients aged ≥50 years (n=19), mean age at surgery was 54.9 years and mean disease duration was 36.6 years. At 2 years postoperatively, rates of Engel I seizure outcome were not significantly different between the two groups (73.9% in the <50 years group versus 94.4% in the ≥50 years group). Although surgical complications were significantly (47.4%) in the older patients, neurological deficit was permanent in only 5.3% of cases. At 1 year postoperatively, neuropsychological outcome did not significantly differ between the two groups.

Conclusions

Patients aged ≥50 years had an excellent seizure outcome at 2 years postoperatively. Early postoperative complications were more frequent in patients aged ≥50 years but were mostly transient. Cognitive outcome was similar to that in younger patients. These findings strongly suggest that age ≥50 years should not be an exclusion criterion for resective epilepsy surgery in patients with drug-resistant TLE.

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Keywords : Epilepsy surgery, Temporal lobe epilepsy, Drug-resistant epilepsy, Seizure outcome, Older adults, Neuropsychological outcome