Time to push the age limit: Epilepsy surgery in patients 60 years or older

Vineet Punia; Ahmed Abdelkader; Robyn M Busch; Jorge Gonzalez-Martinez; William Bingaman; Imad Najm; Andrey Stojic

doi:10.1002/epi4.12099

Time to push the age limit: Epilepsy surgery in patients 60 years or older

Epilepsia Open. 2018 Feb 19;3(1):73-80. doi: 10.1002/epi4.12099. eCollection 2018 Mar.

Authors

Vineet Punia¹, Ahmed Abdelkader¹, Robyn M Busch^{1

2}, Jorge Gonzalez-Martinez^{1

3}, William Bingaman^{1

3}, Imad Najm¹, Andrey Stojic¹

Affiliations

¹ Epilepsy Center Cleveland Clinic Cleveland Ohio U.S.A.
² Psychiatry & Psychology Neurological Institute Cleveland Clinic Cleveland Ohio U.S.A.
³ Department of Neurosurgery Neurological Institute Cleveland Clinic Cleveland Ohio U.S.A.

Abstract

Objective: To summarize the existing literature on resective epilepsy surgery (RES) in older adults (≥60 years old) and examine seizure and neuropsychological outcomes in a single-center large cohort of older adults undergoing RES and their comparison to a consecutive, younger (25- to45-year-old) adult population who underwent RES in routine clinical practice.

Methods: First, a comprehensive literature review was performed. Then, we identified older adults who underwent RES at our center (2000-2015). Outcome analysis was performed on patients who had ≥1 year of clinical follow-up. A younger cohort of patients who underwent RES during the same period was selected for comparison. The 2 groups were compared with respect to demographic and disease variables as well as key clinical outcomes.

Results: Seizure outcomes on 58 older patients were reported in existing literature; 72% achieved Engel class I outcome ≥1 year postoperatively. Sixty-four older adults underwent RES at our center, accounting for 2.8% of all RES during the study period. A total of 51 older adults (M_age = 65) among them had ≥1-year clinical follow-up; 80% achieved Engel I outcome after a mean follow-up of 3.2 years. This was comparable to the 68% Engel class I outcome among 50 consecutive younger adults, despite later age of onset, longer epilepsy duration, and more comorbidities (all p < 0.001) among older adults. The majority (86%) of older adults were referred to our center after years of suffering from drug-resistant epilepsy. There were no group differences in surgical complications. However, 1 older adult passed away post-RES. There was no difference in post-RES neuropsychological outcomes compared to younger adults, except significantly higher number of older adults showed a decline in confrontational naming.

Significance: RES in well-selected older adults is a safe and effective therapy, and advanced age should not preclude consideration of surgical therapy in older adults with pharmacoresistant epilepsy.

Keywords: Elderly; Epilepsy surgery; Geriatric epilepsy; Older adults.