Conference Coverage

Resective epilepsy surgery found OK in septuagenarians


AT AES 2016

HOUSTON – With careful selection, patients in their 70s with refractory epilepsy may be offered resective epilepsy surgery, results from a small single-center study demonstrated.

The findings “were a surprise to us,” lead study author Ahmed Abdelkader, MD, said in an interview at the annual meeting of the American Epilepsy Society. “We expected that complications would be higher because this is a vulnerable age group with multiple comorbidities.”

Dr. Ahmed Abdelkader

Dr. Ahmed Abdelkader

In their abstract, the researchers noted, cases of new-onset epilepsy have increased nearly five-fold over the past 40 years in patients aged 65 and older. “With a rapidly growing, healthier and longer living population, it is a matter of time before we see more and more elderly patients with medical refractory epilepsy who may be potential candidates for resective epilepsy surgery,” they wrote.

Dr. Abdelkader and his associates searched the database of the Cleveland Clinic Epilepsy Center to identify patients aged 70 years and older who underwent respective epilepsy surgery between Jan. 1, 2000, and Sept. 30, 2015. They limited the analysis to seven patients who had at least one year of post-surgical follow-up. The mean age of the patients at surgery was 73 and the age of epilepsy onset ranged from 24-71 years, with a monthly frequency of 4.2 seizures. Their mean Charlson Combined Comorbidity Index score was 4, which translated into a 10-year mean survival probability of 53%. Four of the patients (57%) had a history of significant injuries due to seizures, while all but one had a positive MRI. Three of the patients had hippocampal sclerosis, “which is unique because most cases of hippocampal sclerosis are in younger age groups,” said Dr. Abdelkader, who is currently a research fellow at University Hospitals Case Medical Center, Cleveland.

All patients underwent anterior temporal lobectomy, four on the left side. None had a surgical complication. Six of the seven patients had a good surgical outcome, defined as a Class I or II on the Engel Epilepsy Surgery Outcome Scale, with four being completed free of seizures at one year of follow-up. One of the patients underwent two respective epilepsy surgeries: the first at age 72 and the second at age 75. He died of natural causes, 11 years after his first surgery, and was the only patient to pass away during the follow-up period.

In their abstract, the researchers called for future multi-center collaborative studies “to prospectively study factors influencing respective epilepsy surgery recommendation and its outcome in this rapidly growing population.”

Dr. Abdelkader reported having no financial disclosures.

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