Abstracts

Rationale: Elective surgical intervention for older patients with medically intractable epilepsy is rarely undertaken. In a multicenter cohort of intractable adult epileptic patients, candidates for resective surgery, we compared the clinical and psychosocial outcomes according to the age, epilepsy duration in the surgical group. Methods: Adult patients with a partial medically intractable epilepsy, potentially operable were eligible and followed every 6 months over three years at least. The clinical outcome was the proportion of seizure-free patients (1a, 1b of Engel's classification). Quality of life (QoL) were also measured (QOLIE-31, SEALS, NHP).Results: 289 patients were included (113 with surgery, 167 medically treated, 6 not eligible, 3 lost of follow-up). At 3 years post-surgery, the proportion of seizure-free patients is not different (p=0.80) between older (45-60 yrs) and younger patients: 72.7% (N=5/12) in the older patients vs 77.8% (N=22/61) and the post-surgical complications rate is comparable (33.3% in the older vs 23.1%). The pre-operative duration of epilepsy did not negatively impact on seizure outcome. Independently of the clinical outcome and epilepsy duration, the improvement in QoL is significantly better in older patients for the cognition and overall scores of SEALS and the dimension energy/fatigue of the NHP at 2 yrs. Only the medication effects score of QOLIE-31 is better in younger patients at 2 and 3 yrs post-surgery.Conclusions: Older patients had a favorable post-surgery clinical outcome and no more surgical complications. The dimension cognition of the SEALS and energy/fatigue of the NHP seem more sensitive in older patients. Epilepsy surgery appears as a potentially curative intervention in carefully selected older patients with medically refractory epilepsy.