title: Consideration of epilepsy surgery in adults should be independent of age.
abstract: OBJECTIVE
  Epilepsy surgery is performed less frequently in persons over 45 years of age than in younger individuals, probably reflecting biases among patients, referring physicians and neurologists.
  
  
  METHODS
  We report on a clinically heterogeneous cohort of patients aged 45 years or older who underwent epilepsy surgery for medically intractable epilepsy.
  
  
  RESULTS
  Over a 15-year period, 42 patients with a mean duration of epilepsy of 27.3 years underwent elective surgery. The mean follow-up period was 48 months. Thirty-two patients had an Engel class I outcome, of which 23 were totally seizure-free (Ia). Six patients had a class II outcome (rare disabling seizures), one had a class III outcome (worthwhile improvement), and three had a class IV outcome (no worthwhile improvement). The majority of patients reported an improved quality of life and satisfaction with the epilepsy surgery. A subjective improvement in cognition was reported in 7 patients while a decline was reported in 10 patients. New neuropsychiatric difficulties were reported in three patients while three patients reported improved anxiety after surgery. Only one patient became newly employed after surgery while 23 returned to driving. Permanent complications occurred in four patients (thalamic infarct during a Wada test (n=1) and asymptomatic visual field defect (n=3)).
  
  
  CONCLUSIONS
  We report a favorable outcome from epilepsy surgery in a large series of older adults and conclude that age per se is not a contraindication to epilepsy surgery. We emphasize the lack of correlation between outcome from surgery and pre-operative duration of epilepsy.
authors.affiliation: Epilepsy Service, Department of Neurology, Harvard Medical School, ACC 835, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. djcostello@partners.org
authors.forename: D J
authors.initials: DJ
authors.lastname: Costello
authors.forename: D C
authors.initials: DC
authors.lastname: Shields
authors.forename: S S
authors.initials: SS
authors.lastname: Cash
authors.forename: E N
authors.initials: EN
authors.lastname: Eskandar
authors.forename: G R
authors.initials: GR
authors.lastname: Cosgrove
authors.forename: A J
authors.initials: AJ
authors.lastname: Cole
mesh_terms: D000367:Age Factors; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003071:Cognition; D015331:Cohort Studies; D018572:Disease-Free Survival; D004569:Electroencephalography; D004827:Epilepsy / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D012640:Seizures / Q000453:epidemiology*; D016896:Treatment Outcome