Abstracts

Rationale: Most patients who undergo epilepsy surgery are young adults. Patients above the age of 50 years at surgery only constitute around 7-8% of the series in published reports. Also, most reports focus only on seizure outcome, few on complications and other side effects of surgery. It is important to analyse outcome and complications in this patient group in order to analyse whether epilepsy surgery may be underutilised in older patients. Methods: The Swedish National Epilepsy Register has national coverage and encompasses data on all patients operated in Sweden since 1990. For the purpose of the present study we analysed data for 1990-2004. The study group consisted of all patients who were 50 years or more at the time of surgery and had completed the two-year follow-up, and their outcome and complication rates were compared with corresponding data from all adults (18-49 years) who had undergone resective epilepsy surgery during the period. Our definition of complications is that a minor complication is fully resolved ≤ 3 months, while a major complication persists and to some extent affects daily life. Results: During the studied time period 647 patients underwent resective epilepsy surgery and a two year follow-up in Sweden, 200 of them were children (≤18 years). Of the remaining 447 patients (of whom 318 underwent temporal lobe resections, TLR) 51 patients (of whom 44 underwent TLR) were 50 years or more at surgery, i e 11% of the whole series of adults. The proportion of patients who were seizure free at the two-year follow-up did not differ between adults who were above or below 50 years, neither in the whole series (60.8% versus 60.6%) nor in the TLR group (63.6% versus 61.9%). There was, however, a non-significant trend towards more complications in the older cohort. Major complications occurred in 3.9% of all patients ≥50 years versus 2.8 % of adults <50 years (4.5% versus 2.8% in the patients who underwent TLR) Conclusions: In the Swedish epilepsy surgery series patients over 50 years at operation constitute 11% of all adults who undergo resective epilepsy surgery. The seizure outcome two years after surgery is as good as for the younger adults, but there is a trend towards more complications. Both these aspects constitute important information in the presurgical counselling process. We suggest that epilepsy surgery is underutilised in patients with pharmaco-refractory epilepsy who are 50 years or more.