Surgery for temporal lobe epilepsy associated with mesial temporal sclerosis in the older patient: A long-term follow-up
Article first published online: 19 FEB 2010
Wiley Periodicals, Inc. © 2010 International League Against Epilepsy
Volume 51, Issue 6, pages 1024–1029, June 2010
How to Cite
Murphy, M., Smith, P. D., Wood, M., Bowden, S., O’Brien, T. J., Bulluss, K. J. and Cook, M. J. (2010), Surgery for temporal lobe epilepsy associated with mesial temporal sclerosis in the older patient: A long-term follow-up. Epilepsia, 51: 1024–1029. doi: 10.1111/j.1528-1167.2009.02430.x
- Issue published online: 1 JUN 2010
- Article first published online: 19 FEB 2010
- Accepted October 15, 2009; Early View publication February 19, 2010.
- Temporal lobe epilepsy;
- Hippocampal sclerosis;
- Mesial temporal sclerosis;
- Epilepsy surgery;
- Temporal lobectomy;
- Postoperative seizure outcome
Purpose: To assess the outcomes from temporal lobectomy for hippocampal sclerosis in patients 50 years or older. Controversy exists as to the suitability of older patients for epilepsy surgery, with most of the previous studies demonstrating a correlation between increasing age and poor outcome. However, the inclusion of temporal lobe epilepsy of multiple etiologies has confounded many previous studies of this age group.
Methods: Twenty-one patients aged 50 years or older (mean 54.9 years) at the time of surgery were included in the study group. All patients had a pathologic diagnosis of hippocampal sclerosis. A retrospective analysis was performed comparing seizure outcomes following a standardized anterior temporal lobectomy with those from 103 patients younger than 50 (mean age 34.7 years) operated upon over the same time period. The mean follow-up period for the study was 9.57 years.
Results: Twenty of the 21 patients in the older group (95.2%) had a satisfactory seizure outcome (Engel classes I and II) compared with 90.3% of the younger patients. There was no statistically significant difference in the outcomes between the two groups (p = 0.719). Across both groups of patients combined, there was no significant difference between the mean age in the patients with a satisfactory seizure outcome compared to those with an unsatisfactory outcome (38.3 vs. 34.7 years, p = 0.213).
Discussion: Patients 50 years or older with intractable seizures from hippocampal sclerosis have seizure outcomes following temporal lobectomy that are comparable to young patients over the long term. Older patients should not be denied treatment on the basis of age.