Epilepsy surgery beyond 50â¯years: Long-term seizure and cognitive outcomes.
J Neurol Sci
; 414: 116872, 2020 Jul 15.
Article
em En
| MEDLINE
| ID: mdl-32388063
ABSTRACT
INTRODUCTION:
Surgery is a well-demonstrated effective treatment for patients with refractory epilepsy. However, there are scarce data about the efficacy in older patients. Endpoint was to evaluate the outcome of epilepsy surgery in pharmacorresistant patients operated in middle-late adulthood.METHODS:
We conducted a retrospective observational study including patients who underwent a epilepsy surgery at ageâ¯≥â¯50. Presurgical clinical data, type of surgery, and postsurgical seizure outcome and neurological complications, including neuropsychological assessment were analyzed. Minimum post-surgical follow-up was 1â¯year.RESULTS:
We identified 38 patients (22 males, 17 females) out of 350 patients who underwent a resective surgery with curative intention in our Epilepsy Unit (12%). Median age at surgery was 56â¯years (50-69), with median epilepsy duration of 42â¯years (4-67). Neuroimaging showed focal epileptogenic lesions in 37 patients, mainly mesial temporal sclerosis (21). Presurgical neuropsychological evaluation was available in 38 patients 35 had deficits, mostly in verbal or visual memory. Twenty-eight patients underwent standard temporal lobectomy with amygdalohippocampectomy, 7 lesionectomy and 4 lobectomy. Median follow-up was 4.46â¯years (1-9.75). A good outcome was achieved by 86.8% (28 Engel I; 5 Engel II); 5 patients were studied with SEEG, without any complications. None had postsurgical permanent neurological complications. From 22 patients with available post-surgical neuropsychological assessment, 16 scored lower than in pre-surgical one, mainly in memory domain.CONCLUSION:
Surgical treatment of long-term refractory epilepsy in patients ≥50â¯years can be effective and safe. Post-surgical memory decline is a frequent side effect, but with a low impact in daily life.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Epilepsia
/
Epilepsia do Lobo Temporal
Tipo de estudo:
Observational_studies
/
Prognostic_studies
Limite:
Adult
/
Aged
/
Female
/
Humans
/
Male
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article