Abstracts

Rationale: The etiology of epilepsy in the elderly is reported mainly to be traumatic brain injury, cerebrovascular disease and brain tumor. With these causes, prevalence rate of epilepsy increases among the elderly. Treatment strategy for elderly patients has become crucial topic especially in developed country where life expectancy is rapidly getting longer. However, clinical evidence of surgical treatment for elderly patients has not been established. This study focuses on clinical benefit and adverse effect of epilepsy surgery in the elderly. Methods: A systematic review of clinical articles published between 1990 and 2016 were conducted by searching PubMed/MEDLINE database. Search terms consist of “Epilepsy” AND (“old” OR ‘elderly”) AND “surgery” AND “outcome”. In total, 419 articles met this search criteria, then case reports, expert opinion and technical notes were excluded. Finally, 19 reports were analyzed in regard to seizure outcome, effects on cognitive function, psychosocial roles and surgical complication. In addition to this literature review, eight elderly patients surgically treated by the author were analyzed from the same viewpoints. Results: Many articles reported that the outcome of seizure reduction rate in the elderly was same as in younger patients, but also pointed out that surgical manipulation in left temporal lobe in the elderly could worsen verbal memory. Improvement of psychosocial role and reemployment rate after surgery was not as comparable as younger population. Surgical complication was not always higher in the elderly. As for vagus nerve stimulation, several reports suggested equivalent clinical benefit to both younger and elderly patients. Conclusions: Surgical treatment in elderly patients could achieve satisfactory seizure reduction comparable to younger population. Some caution is required regarding verbal memory decline after surgery in left temporal lobe. Funding: None