Abstracts

Epilepsy surgery is considered to be the most effective treatment in refractory epilepsy with seizure free outcomes from 45% to 67.9% (Engel J. Surgery for seizures. N Engl J Med 1996;334:647-652). However, little data exists on the number of older patients who are treated surgically, the post surgical complications and outcome rates in this patient population., We identified all patients who were 50 years and older and had epilepsy surgery for refractory epilepsy at Henry Ford Hospital (HFH) Epilepsy Program from 1994 to 2005. Data on age at surgery, duration of epilepsy, risk factors, noninvasive and invasive video/EEG monitoring, surgery site, pathology, outcome, and medical conditions at surgery as well as complications were collected through search of the Epilepsy Monitoring Unit admission database and the HFH electronic database (CarePlus). Patients who had tumors that presented with seizures and surgery was performed in the context of tumor treatment were not included. Descriptive statistics were applied., Thirty five patients from 50 to 70 years old (median age=55; 19 females) underwent epilepsy surgery at HFH. Duration of epilepsy was from 6 months to 50 years (median = 35 years). Nineteen patients (54%) with inconsistent localization during scalp continuous video EEG monitoring had invasive monitoring with grids, strips and/or depth electrodes. Thirty one patients had temporal resections (16 had left anterior temporal resection), 3 extratemporal and one subpial transection. Pathology revealed mesial temporal sclerosis in 14 patients, heterotopia in 2, dual pathology in 2, cavernous angioma in 2, dysembryoplastic neuroepithelial tumor in 1. In the remainder pathology was consistent with various degrees of gliosis or non diagnostic. Duration of follow up ranged from 1 month to 13 years (median follow up = 2 years). One patient was lost to follow up. Twenty five patients (25/34; 73.5%) were seizure free after surgery, 4 of which remained seizure free off antiepileptic medication. Medical history prior to surgery was consistent with hypertension (HTN) in 6 patients, hypercholesterenemia and HTN in 3, diabetes and HTN in 2 and coronary artery disease in 3 (2 of which had previous angioplasty). One patient had right MCA infarct one day after surgery that resulted in mild left hemiparesis. Following surgery, 1 patient developed transient angina and another one pulmonary embolism that was successfully treated., Surgical treatment of refractory epilepsy in older patient population is a safe treatment and yields seizure freedom outcomes that are comparable to those reported in young patients. Co-morbid conditions and advanced age should not prevent physicians from offering epilepsy surgery to appropriate candidates.,