Abstracts

Rationale: Epilepsy surgery for medically refractory epilepsy can be a very effective treatment for some patients who continue to have recurrent, debilitating seizures despite maximal anti-epileptic drugs. Because epilepsy surgery is considered an elective treatment procedure, potential benefits must be weighed against risk for surgical complications. As with any surgical intervention, age is a major factor contributing to perioperative morbidity. The purpose of this study is to assess the efficacy and the complication rate of epilepsy surgery in a cohort of patients 50 years and older. Methods: Chart review was conducted on 132 patients aged 13 and older who underwent epilepsy surgery at Kaiser Permanente Los Angeles Medical Center from 1993 to 2006. Patients were included only if the primary purpose for the operation was to improve seizure control. Data was collected by medical paper and electronic chart review of the office notes and, when necessary, telephone or email contact with the patient or an immediate family member to obtain information. Data collected include demographic characteristics, age at time of operation, complications, and postoperative seizure outcome using the Engel rating classification. Results: Of the 132 patients reviewed, 22 were aged 50 or older (range 50-64, average age 53.9, median age 53). 13 were female and 9 were male. 14 underwent en bloc temporal lobectomy and 8 underwent a selective amygdalohippocampectomy. There were no extratemporal or temporal neocortical resections. At 1 year, 1 patient was lost to follow up, 12/21 (57%) had Engel Class I, 2/21 (9.5%) had Engel Class II, and 7/21 (16%) had Engel Class III/IV outcomes . At 2 years, 2 patients were lost to follow up, 13/20 (65%) had Engel Class I, 3/20 (15%) had Engel Class II, and 4/20 (20%) had Engel Class III/IV outcomes. 5/22 (23%) patients had perioperative complications. There were 110 patients age 13 to 49 in this cohort (average age 32.9, median age 34) (64 female, 46 male). 37 underwent selective AHC, 59 underwent en bloc temporal lobectomy, 10 underwent extratemporal neocortical resection and 4 underwent temporal neocortical resections. At 1 year, 7 patients were lost to follow up, 82/103 (80%) had Engel Class I, 7/103 (7%) had Engel Class II, 14/103 (13%) had Engel Class III/IV outcomes. At 2 year, 13 patients were lost to follow up, 74/97 (76%) had Engel Class I, 3/97 (3%) had Engel Class II, 20/97 (21%) had Engel Class III/IV outcomes. 4/110 (3.6%) patients had perioperative complications. Conclusions: Focal resective epilepsy surgery remains an effective treatment for medication resistant partial epilepsy in patients aged 50 and older but is associated with somewhat greater perioperative risks compared with younger patients.