Outcomes of epilepsy surgery for medically refractory temporal lobe epilepsy in older patients
Main Article Content
Purpose: Resective epilepsy surgery for temporal lobe epilepsy (TLE) remains underutilized in elderly patients and only few studies report postsurgical seizure and neurocognitive outcomes in this group. The aim of this study was to investigate the tolerability and efficacy of surgery in older epileptics.
Methods: We conducted a retrospective analysis of 18 patients aged 55 or older to assess the efficacy and tolerability of the procedure. Mean disease duration was 34 years.
Results: Fourteen patients (78%) achieved Engel class I outcome over a mean follow-up period of 4.2 years. Thirteen patients had neuroimaging and histopathology consistent with mesial temporal sclerosis (MTS). We did not find a measurable effect of disease duration on postsurgical outcome. We confirmed that the MRI evidence of MTS can be used as a predictor for postsurgical outcome. Postsurgical neuropsychological evaluation completed in 13 patients between three months and two and a half years post resection showed decline in verbal abilities most significantly in those who had undergone dominant temporal lobe surgery.
Discussion: Our results indicate that epilepsy surgery is well tolerated, safe and effective in older patients with refractory TLE. Postsurgical neuropsychological evaluation showed expected decline in verbal abilities in patients who had undergone dominant resection.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
 Acosta I., F. Vale, W.O. 4th Tatum, and S.R. Benbadis. 2008. “Epilepsy surgery after age 60.” Epilepsy Behav 12 (2):324-5.
 Bengzon A.R., T. Rasmussen, P. Gloor, J. Dussault, and M. Stephens.1968. “Prognostic factors in the surgical treatment of temporal lobe epileptics.” Neurology 18(18):717–31.
 Blume W.T., H. B. Desai, J. P. Girvin, R.S. McLachlan, and J.F. Lemieux.1994. ”Effectiveness of temporal lobectomy measured by yearly follow-up and multivariate analysis.” J Epilepsy 7(3):203–14.
 Boling W., F. Andermann, D. Reutens, F. Dubeau, L. Caporicci, and A. Olivier.2001. “Surgery for temporal lobe epilepsy in older patients.” J Neurosurg 95(2):242–8.
 Cascino G.D., F. W. Sharbrough, K. A. Hirschorn, and W.R. Marsh. 1991. “Surgery for focal epilepsy in the older patient.” Neurology 41(9) :1415-1417.
 Costello D.J., D.C. Shields, S.S Cash, E.N. Eskandar, G.R. Cosgrove, and A.J. Cole. 2009.”Consideration of epilepsy surgery in adults should be independent of age.” Clin Neurol Neurosurg 111(3):240-5. doi: 10.1016/j.clineuro.2008.10.005.
 Dulay M.F. and R. M. Busch. 2012. “Prediction of neuropsychological outcome after resection of temporal and extratemporal seizure foci.” Neurosurg Focus 32(3), E4. doi:10.3171/2012.1.FOCUS11340.
 Faught E., J. Richman, R. Martin, E. Funkhouser, R. Foushee, P. Kratt, Y. Kim, K. Clements, N. Cohen, D. Adoboe, R. Knowlton, and M. Pisu. 2012. “Incidence and prevalence of epilepsy among older US Medicare beneficiaries.” Neurology 78 (7): 448-53. doi: 10.1212/WNL.0b013e3182477edc. Epub 2012 Jan 18.
 Grivas A., J. Schramm, T. Kral, M. von Lehe, C. Helmstaedter, C.E. Elger, and H. Clusmann. 2006. “Surgical Treatment for Refractory Temporal Lobe Epilepsy in the Elderly: Seizure Outcome and Neuropsychological Sequels Compared with a Younger Cohort.” Epilepsia 47 (8):364–72.
 Janszky J., I. Janszky, R. Schulz, M. Hoppe, F. Behne, H.W. Pannek, and A. Ebner. 2005. ”Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome.” Brain 128(Pt 2):395-404.
 Jeong S.W., S. K. Lee, K.K. Kim, H. Kim, J.Y. Kim, and C.K. Chung. 1999. “Prognostic factors in anterior temporal lobe resections for mesial temporal lobe epilepsy: multivariate analysis.” Epilepsia 40(12):1735–9.
Leonard G. 1991. “Temporal lobe surgery for epilepsy: neuropsychological variables related to surgical outcome.” Can J Neurol Sci 18(4 Suppl):593-7.
 Malmgren K., M. Sullivan, G. Ekstedt, G. Kullberg, and E. Kumlien.1997. “Health-related quality of life after epilepsy surgery: a Swedish multicenter study.” Epilepsia 38(7): 830–8.
 McLachlan R.S., C. J. Chovaz, W. T. Blume, and J.P. Girvin.1992. “Temporal lobectomy for intractable epilepsy in patients over age 45 years.” Neurology 42 (3 Pt 1):662-5.
 Murphy M., P.D. Smith, M. Wood, S. Bowden, T.J.O’Brien, K.J. Bulluss, and M.J. Cook. 2010. “Surgery for temporal lobe epilepsy associated with mesial temporal sclerosis in the older patient: a long term follow-up.” Epilepsia 51 (6), pp. 1024-9. doi: 10.1111/j.1528-1167.2009.02430.
 Potter J.L., B.K. Schefft, D. W. Beebe, S.R. Howe, H.S. Yeh, and M.D. Privitera. 2009. “Presurgical neuropsychological testing predict cognitive and seizure outcomes after anterior temporal lobectomy.” Epilepsy Behav 16(2):246-53. doi: 10.1016/j.yebeh.2009.07.007.
 Rausch R., S. Kraemer, C. J. Pietras, M. Le, B.G. Vickrey, and E.A. Passaro. 2003.” Early and late cognitive changes following temporal lobe surgery for epilepsy.”Neurology 60(6):951-9.
 Roberson E.D., O.A. Hope, R.C. Martin, and D. Schmidt. 2011. “Geriatric epilepsy: research and clinical directions for the future.” Epilepsy Behav 22 (1):103-11.
 Selwa L.M., S. Berent, B. Giordani, T.R. Henry, H.A. Buchtel, and D.A.Ross. 1994. “Serial Cognitive Testing in Temporal Lobe Epilepsy: Longitudinal Changes with Medical and Surgical Therapies.” Epilepsia 35(4):743-9.
 Sirven J.I., B.L. Malamut, M.J. O’Connor, and M.R. Sperling. 2000. ”Temporal lobectomy outcome in older versus younger adults.” Neurology 54(11):2166–70.
 Srikijvilaiku T., S. Lerdlum, S. Tepmongkol, S. Shuangshoti, and C. Locharernkul. 2011. “Outcome of temporal lobectomy for hippocampal sclerosis in older patients.” Seizure 20 (4):276-9. doi: 10.1016/j.seizure.2010.12.008.