WASHINGTON, DC—Surgery in older patients with epilepsy has the potential to improve overall health and quality of life, as well as provide a favorable seizure outcome, according to a study presented at the 67th Annual Meeting of the American Epilepsy Society.
Investigators at the University of California, Los Angeles (UCLA), reviewed the records of 10 patients who had undergone resective epilepsy surgery for medically refractory focal onset seizures at their institution between 1992 and 2012. Patients ages 60 and older (age range: 60 to 74) with a minimum follow-up of one year (range 1 to 7.5 years) were included in the study. Comorbidities at the time of surgery, including hypertension, hyperlipidemia, diabetes mellitus, hypothyroidism, osteoporosis, obstructive sleep apnea, depression, and falls, were noted. A modified Liverpool life satisfaction tool was administered postoperatively, with a maximum score of 40.
Patients’ mean age at surgery was 65.4. The mean duration of epilepsy before surgery was 27.8 years. At the time of surgery, 70% of patients had at least one medical comorbidity in addition to refractory seizures. No patients experienced any postsurgical complications.
The patients were followed for a mean of 3.2 years. At the time of final follow-up, 90% of patients had a good postsurgical outcome. Half of patients were completely seizure free. Quality of life data were available for nine patients, whose mean modified Liverpool life satisfaction score was 30.4 after surgery. Of the nine patients with additional life satisfaction data, six reported excellent satisfaction with their surgery, and three reported postoperative improvements in their health.
Resective surgery is seldom used in epilepsy patients ages 60 and older despite its potential to offer seizure freedom. Older age may discourage referrals to specialized epilepsy centers, given concerns about increased surgical risk because of age and the presence of other health problems common in the elderly.
“Our data demonstrate that referral to a comprehensive epilepsy center for resective epilepsy surgery evaluation should not be negatively influenced by advancing age,” said Sandra Dewar, RN, Patient Care Coordinator at UCLA Health and the lead study author. “Consideration of surgery in older adults is important, since seizure freedom may increase safety, independence, and happiness later in life.”
—Erik Greb