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 the 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.”
Surgical Site May Influence Epilepsy Surgery’s Effect on Mood and Behavior in Children
Epilepsy surgery may improve mood and behavior among children, researchers reported at the 67th Annual Meeting of the American Epilepsy Society. The hemisphere on which surgeons operate may influence the effect of surgery.
Children with epilepsy are at high risk for depression, anxiety, and behavioral functioning disorders. Epilepsy surgery in children is associated with changes or improvements in mood and behavior, but research into the extent of the change has produced inconsistent results.
To examine changes in mood, anxiety, and behavioral functioning following epilepsy surgery, a collaborative team of investigators from the Cleveland Clinic and the University of Pittsburgh studied 101 children (ages 5 to 16) who underwent epilepsy surgery. The investigators analyzed the role of surgical site (ie, frontal or temporal) and hemisphere (ie, left or right) in the outcomes.
Children in the study completed the Children’s Depression Inventory (CDI) and the Revised Children’s Manifest Anxiety Scale (RCMAS) as part of comprehensive neuropsychologic evaluations conducted approximately 10 months apart. The children’s primary caregivers completed the Achenbach Child Behavior Checklist (CBCL) at both evaluations.
Among children who underwent left-sided surgeries, patients with frontal lobe epilepsy or their caregivers endorsed more symptoms on the Social Anxiety subscale of the RCMAS and on the Withdrawal subscale of the CBCL before surgery than patients with temporal lobe epilepsy. Patients with frontal lobe epilepsy also demonstrated notable improvement in anxiety or mood following surgery. The investigators found no significant two-way interactions among children who underwent right-sided surgeries.
In addition, 21% of all patients (ie, 15% of patients with temporal lobe epilepsy and 33% of patients with frontal lobe epilepsy) reported improvements in overall depression symptoms after surgery. About 38% of the cohort (ie, 27% of patients with temporal lobe epilepsy and 45% of patients with frontal lobe epilepsy) reported postoperative improvements in overall anxiety symptoms.
“We were pleased to discover that children generally experience improvements in mood and behavior following epilepsy surgery,” said Elizabeth Andresen, PhD, postdoctoral fellow in neuropsychology at the Cleveland Clinic and lead author of the study. “While children with frontal lobe epilepsy had greater symptoms of depression and anxiety before surgery than children with temporal lobe epilepsy, these symptoms improved significantly following surgery to levels comparable to or below [those of] the temporal lobe group. Interestingly, these relationships were most apparent in children who underwent left-sided surgeries.”