Surgery for temporal lobe epilepsy associated with mesial temporal sclerosis in the older patient: a long-term follow-up.
OBJECTIVE
To assess the outcomes from temporal lobectomy for hippocampal sclerosis in patients 50 years or older. Controversy exists as to the suitability of older patients for epilepsy surgery, with most of the previous studies demonstrating a correlation between increasing age and poor outcome. However, the inclusion of temporal lobe epilepsy of multiple etiologies has confounded many previous studies of this age group.


METHODS
Twenty-one patients aged 50 years or older (mean 54.9 years) at the time of surgery were included in the study group. All patients had a pathologic diagnosis of hippocampal sclerosis. A retrospective analysis was performed comparing seizure outcomes following a standardized anterior temporal lobectomy with those from 103 patients younger than 50 (mean age 34.7 years) operated upon over the same time period. The mean follow-up period for the study was 9.57 years.


RESULTS
Twenty of the 21 patients in the older group (95.2%) had a satisfactory seizure outcome (Engel classes I and II) compared with 90.3% of the younger patients. There was no statistically significant difference in the outcomes between the two groups (p = 0.719). Across both groups of patients combined, there was no significant difference between the mean age in the patients with a satisfactory seizure outcome compared to those with an unsatisfactory outcome (38.3 vs. 34.7 years, p = 0.213).


CONCLUSIONS
Patients 50 years or older with intractable seizures from hippocampal sclerosis have seizure outcomes following temporal lobectomy that are comparable to young patients over the long term. Older patients should not be denied treatment on the basis of age.
Murphy
Michael
M
Victorian Epilepsy Centre and Centre for Clinical Neuroscience and Neurological Research, St Vincent's Hospital, Melbourne, Australia. michael.murphy@svhm.org.au
Smith
Paul D
PD
Wood
Martin
M
Bowden
Stephen
S
O'Brien
Terence J
TJ
Bulluss
Kristian J
KJ
Cook
Mark J
MJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D038481:Anterior Temporal Lobectomy / Q000639:trends; D004833:Epilepsy, Temporal Lobe / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012598:Sclerosis / Q000150:complications / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome