Abstracts

Rationale: Epilepsy surgery in the elderly population has been controversial. The concern for patients with long-lasting epilepsy as well as higher surgical risk has rendered this group of individuals as non-candidates for surgery. Literature suggests that this group can benefit from surgery. Our objective was to analyze the role of resective surgery in patients over 60 years old, assessing outcomes and safety. Methods: We conducted a retrospective analysis of 595 patients who underwent resective epilepsy surgery at our center from 1999-2019 (20 years). 31 patients who were 60 years of age or older were identified. 60 patients of 59 years of age or younger were randomly selected as control group. Population characteristics, presurgical evaluations, postoperative outcome, and complications were analyzed. Results: No significant differences were found between both groups in terms of hemisphere dominance, side of surgery, lesional/non-lesional ratio, and incidence of TLE over extratemporal epilepsy although the latter was more frequent in the Old group. Age (p<0.0001), duration of epilepsy (p=0.0192), and the need for invasive recording in younger patients (p=0.0298) were statistically significant. Engel I at 6 months, 1 year, and 2 years were 92.9%, 88.5%, and 94.7% for the Old group and 75% (p=0.0794), 63.5% (p=0.0313), and 75.8% (p=0.1304) for the Young group, respectively. The subgroup of temporal lobe epilepsy (TLE) exhibited a better seizure outcome for both groups but was higher in the Old group. Complication rates were higher in the Old group but not significant. Conclusions: Epilepsy surgery in older patients had better outcomes at one year than in general population. A tendency towards lesional TLE may explain this bias. Although surgical risk might be higher, decision to operate should be individualized on patient’s inherent risk and not due to age. Funding: No funding