Predictive factors of postoperative outcome in the elderly after resective epilepsy surgery
Abstract
ABSTRACT Objective: To evaluate the efficiency of resective epilepsy surgery (RES) in patients over 50 years and determine prognostic factors. Results: Over the 147 patients over 50 years (54.9 ± 3.8 years [50-69]) coming from 8 specialized French centres for epilepsy surgery, 72.1%, patients were seizure-free and 91.2% had a good out- come 12 months after RES. Seizure freedom was not associated with the age at surgery or duration of epilepsy. In multivariate analysis, seizure freedom was associated with MRI and neuropathologi- cal hippocampal sclerosis (HS) (p = 0.009 and p = 0.028 respectively), PET hypometabolism (p = 0.013), temporal epilepsy (p = 0.01). On the contrary, the need for intracranial exploration was as- sociated with a poorer prognosis (p = 0.001). Postoperative number of antiepileptic drugs was sig- nificantly lower in the seizure-free group (p = 0.001). Neurological adverse event rate after surgery was 21.1% and 11.7% of patients had neuropsychological adverse effects overall transient. Conclusions: RES is effective procedure in the elderly. Even safe it remains at higher risk of com- plication and population should be carefully selected. Nevertheless, age should not be considered as a limiting factor, especially when good prognostic factors are identified.
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