Epilepsia 0 Suppl. 0 (Abst. 2.274 ), 2008
OLDER PATIENTS ARE LESS LIKELY TO ACHIEVE SEIZURE FREEDOM
AND MORE LIKELY TO HAVE NEUROPSYCHOLOGICAL DECLINE
THAN YOUNGER PATIENTS AFTER EPILEPSY SURGERY
Authors: Erica Schuyler, H. Buchtel and L. Hudson
To be presented to the 62nd Annual Meeting of the American Epilepsy Society, Seattle, Washington, December 5-9, 2008.
ABSTRACT
RATIONALE:
Published outcome data for older patients undergoing epilepsy surgery is
limited and shows variable results. In this study, retrospective data was
collected from 52 epilepsy surgery patients, including both temporal and
extra-temporal resections. Seizure outcome and neuropsychological testing
data was compared between older and younger groups. The disparity we found
between the older and younger groups was greater in our data sample than
in previous reports.
METHODS:
Patients were included in the study if they were over 18 years old at the
time of surgery, underwent epilepsy surgery since the year 2000, completed
both preoperative and postoperative neuropsychological testing, and had
follow-up clinic visits documenting seizure outcome information. We
compared seizure outcome and neuropsychological testing data between two
patient groups defined by age >40 (N=23) and age <40 (N=29) at time of
surgery using Chi Square tests.
RESULTS:
The mean age of the older group was 49.3 years with mean epilepsy duration
of 25.3 years. The younger group had a mean age of 29.2 years with a mean
duration of epilepsy of 17.7 years. The mean postoperative follow-up
period was 2 years, which did not differ between groups. Ten (43%) of the
older patients had an Engel class I outcome compared to 24 (83%) of the
younger patients which was statistically significant (p<0.01 using Chi
square test). Neuropsychological testing was done a mean of 8.9 months
after surgery and compared with preoperative data. Twelve (52%) of the
older patients had a decline compared to seven (24%) of the younger
patients (p<0.05 using Chi square test).
CONCLUSIONS:
The percentage of older patients who achieved seizure freedom was
significantly less than the younger patients. The percentage of older
patients who had notable neuropsychological decline was also significantly
higher than in the younger patients. Although a majority of patients in
both groups had a significant seizure reduction, the counseling of older
patients in regards to the potential outcome of surgery may need to be
adjusted.