Sandra Dewar1, Dawn Eliashiv1, Patricia D Walshaw2, Jerome Engel1, Itzhak Fried3, Brian D Moseley4. 1. Departments of 1 Neurology. 2. Psychiatry and Biobehavioral Sciences, and. 3. Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California; and. 4. Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Ohio.
Abstract
OBJECTIVE: Despite its potential to offer seizure freedom, resective epilepsy surgery (RES) is seldom performed in patients 60 years of age or older. Demonstrating successful outcomes including an improved quality of life may raise awareness about the advantages of referring this underrepresented population for specialized evaluation. Accordingly, the authors investigated outcomes and life fulfillment in patients with an age ≥ 60 years who had undergone RES. METHODS: All patients who, at the age of 60 years or older, had undergone RES for medically refractory focal onset seizures at the authors' center were evaluated. A modified Liverpool Life Fulfillment (LLF) tool was administered postoperatively (maximum score 32). Seizure outcomes were classified according to the Engel classification system. RESULTS: Twelve patients underwent RES. The majority of patients (9 [75%] of 12) had at least 1 medical comorbidity in addition to seizures. The mean follow-up was 3.1 ± 2.1 years. At the time of the final follow-up, 11 (91.7%) of 12 patients were documented as having a good postsurgical outcome (Engel Class I-II). Half (6 of 12 patients) were completely seizure free (Engel Class IA). Liverpool Life Fulfillment (LLF) data were available for 11 patients. Following surgery, the mean LLF score was 26.7 ± 6. Eight patients (72.7%) noted excellent satisfaction with their RES, with 5 (45.5%) noting postoperative improvements in overall health. CONCLUSIONS: Resective epilepsy surgery is safe and effective in patients with an age ≥ 60 years. Over 90% had a good surgical outcome, with 50% becoming completely seizure free despite 1 or more medical comorbidities in the majority. The study data indicated that an advancing age should not negatively influence consideration for RES.
OBJECTIVE: Despite its potential to offer seizure freedom, resective epilepsy surgery (RES) is seldom performed in patients 60 years of age or older. Demonstrating successful outcomes including an improved quality of life may raise awareness about the advantages of referring this underrepresented population for specialized evaluation. Accordingly, the authors investigated outcomes and life fulfillment in patients with an age ≥ 60 years who had undergone RES. METHODS: All patients who, at the age of 60 years or older, had undergone RES for medically refractory focal onset seizures at the authors' center were evaluated. A modified Liverpool Life Fulfillment (LLF) tool was administered postoperatively (maximum score 32). Seizure outcomes were classified according to the Engel classification system. RESULTS: Twelve patients underwent RES. The majority of patients (9 [75%] of 12) had at least 1 medical comorbidity in addition to seizures. The mean follow-up was 3.1 ± 2.1 years. At the time of the final follow-up, 11 (91.7%) of 12 patients were documented as having a good postsurgical outcome (Engel Class I-II). Half (6 of 12 patients) were completely seizure free (Engel Class IA). Liverpool Life Fulfillment (LLF) data were available for 11 patients. Following surgery, the mean LLF score was 26.7 ± 6. Eight patients (72.7%) noted excellent satisfaction with their RES, with 5 (45.5%) noting postoperative improvements in overall health. CONCLUSIONS: Resective epilepsy surgery is safe and effective in patients with an age ≥ 60 years. Over 90% had a good surgical outcome, with 50% becoming completely seizure free despite 1 or more medical comorbidities in the majority. The study data indicated that an advancing age should not negatively influence consideration for RES.
Entities:
Keywords:
AMTL = anteromesial temporal lobe; EEG = electroencephalography; LLF = Liverpool Life Fulfillment; QOL = quality of life; RES = resective epilepsy surgery; UCLA = University of California, Los Angeles; epilepsy surgery; older patients; outcomes; quality of life
Authors: Jon T Willie; Nealen G Laxpati; Daniel L Drane; Ashok Gowda; Christina Appin; Chunhai Hao; Daniel J Brat; Sandra L Helmers; Amit Saindane; Sherif G Nour; Robert E Gross Journal: Neurosurgery Date: 2014-06 Impact factor: 4.654
Authors: Baemisla Shiek Ahmad; Keith David Hill; Terence John O'Brien; Alexandra Gorelik; Natalie Habib; John Dennis Wark Journal: Neurology Date: 2012-06-13 Impact factor: 9.910
Authors: Athanasios Grivas; Johannes Schramm; Thomas Kral; Marec von Lehe; Christoph Helmstaedter; Christian E Elger; Hans Clusmann Journal: Epilepsia Date: 2006-08 Impact factor: 5.864