title: Anterior temporal lobectomy for older adults with mesial temporal sclerosis.
abstract: To compare postoperative seizure-free survival between older and younger adults.
  
  
  
  A retrospective cohort of 107 temporal lobe epilepsy patients with a diagnosis of mesial temporal sclerosis (MTS) received anterior temporal lobectomy (ATL) between 1993 and 2014. We divided the lower three quartiles (younger) and top quartile (older, all 47+ years) of patients, then reviewed patient registry and electronic medical records to determine time to first self-reported seizure after ATL, the primary outcome (mean=3.5years of follow-up, SD=3.6). We also assessed Engel classifications, intraoperative and postoperative treatment complications, and social disability. We used Cox proportional hazard models to assess the association between individual traits and time of seizure recurrence.
  
  
  
  During follow-up, 35/107 (32.7%) patients had post-operative seizure(s). After adjustment for potential confounders there were no significant differences in the probability of post-operative seizures between the older and younger groups, though we had limited precision (hazard ratio of 0.67 [0.28-1.59]), (p=0.36). There were more treatment complications and disability in older patients (18% vs. 1.3% for any complications, 84.62% vs. 58.23% for driving disability, and 84.6% vs. 60.7% for work disability, p<0.05).
  
  
  
  Older patients appear to have more complications after ATL, compared with younger patients. Age, however, does not appear to have a large independent association with seizure recurrence.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States. Electronic address: lidia.moura@mgh.harvard.edu.
authors.forename: Lidia M V R
authors.initials: LM
authors.lastname: Moura
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Emad N
authors.initials: EN
authors.lastname: Eskandar
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Mursal
authors.initials: M
authors.lastname: Hassan
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Joel
authors.initials: J
authors.lastname: Salinas
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cole
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Hoch
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, United States.
authors.forename: Sydney S
authors.initials: SS
authors.lastname: Cash
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA 02114, United States; Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, United States.
authors.forename: John
authors.initials: J
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D038481:Anterior Temporal Lobectomy; D004185:Disability Evaluation; D000069279:Drug Resistant Epilepsy / Q000453:epidemiology / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012598:Sclerosis / Q000453:epidemiology / Q000601:surgery; D012640:Seizures / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Age; Anterior temporal lobectomy; Mesial temporal sclerosis