Abstracts

Rationale: As age related declination of cognitive functioning is a generally accepted phenomenon, even though results are controversial. The aging is negatively interacting with a pre-damaged brain capability and a surgical intervention has touched upon the memory brain structures. Our study focused on the post-surgical memory development in patients aged over 45 years who underwent the mesiotemporal epilepsy surgery.Methods: Our sample consists of 88 pharmacoresistant patients (52 male and 36 female) who underwent TLES with hippocampus resection in Brno Epilepsy center between 1999 and 2006 (Tab 1) . We have collected history of disease from all patients and they underwent complete pre-surgical evaluation. All patients pre-operatively underwent complex neuro-psychological evaluation. The Wechsler memory test III was applied before a surgery, 1 year and 3 years after surgery, if possible also 5 and 10 years after surgery. Results: We found out memory decline in 41.7 % patients in age group 45 years, in 55.6 % in age group 31 - 44 years and in 32.4 % of patients 30 years . We found out significant memory change (decrease) from pre surgical evaluation to 3rd year after surgery in all TLE patients, however, the MQ in the group of patients with MTS significantly decreased while in the group of patients without MTS the decline was only on the edge of significance (see table 2). Patients with lower pre-surgical MQ have worsened less or did not suffer change of memory after surgery at all when compared to those with higher pre-surgical MQ. The age groups with MTS differ significantly, whereas the age groups with the non-MTS didn t. Concerning the MTS, the pre-surgical MQ with age group over 45 was significantly below that with both of younger group up to 30 years and 30 44 yaers. There wasn t decrease from pre-surgery to the first post-surgery memory evaluation in neither the MTS, nor the non-MTS group. The MQ significantly decreased in the MTS group between post-surgery 1st year and post-surgery 3rd year evaluations (see table 2). The MQ did not change significantly in the first period in any of the MTS age groups. Regarding the second period, the MQ in the two MTS younger groups, e.g. 30 years and 31 to 44 years declined. However, the MQ did not decline significantly in the group above 45. The age group 45 also showed worse outcome with Engel s classification Engel s I =58.3% compared to 82.5% and 80% in younger groups), though chisq. test was not significant. Conclusions: Our data has shown that almost two-thirds of patients did not suffer memory deterioration after TLE surgery. The outcome was slightly worse in older patients, but this result did not reach statistical significance. The MTS patients who had surgery at age over 45 years have significantly lower pre-operative MQ than younger patients that probably results from pre-surgical damage of functional integrity of mesial and cortical temporal structures. Because of it, the surgery should be done as soon as possible. The epilepsy surgery is worth doing in patients older than 45 years.