Epilepsy in the Elderly

Ann Johnston; Phil EM Smith


Expert Rev Neurother. 2010;10(12):1899-1910. 

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Elderly patients with medically intractable epilepsy and an underlying structural cerebral lesion should be considered for surgical treatment. The presurgical work-up is similar to that in younger patients, including video EEG and magnetic resonance brain scanning (with functional imaging if indicated) and neuropsychometry. However, there are limited data on the long-term outcomes of resective epilepsy surgery in elderly patients. As at any age, outcomes are better when there is a clear structural cause. Patients with epilepsy from brain trauma or those who develop postoperative seizures have poorer outcomes.[66] Surgical outcomes do not appear to correlate with age (including age at onset), sex, epilepsy duration, etiology (tumor versus hippocampal sclerosis) or frequency of perioperative seizures.[67] Grivas et al. demonstrated promising outcomes in patients with temporal lobe epilepsy who were older than 60 years, despite a long seizure history. As expected, the risk of complications was somewhat higher than with the younger control group.[68]

Vagus nerve stimulation has not been widely tested in elderly populations. In general, robust outcome data are lacking, apart from industry-sponsored work. Perhaps a third of patients experience a 50% reduction in seizure frequency, another third have a 30–50% seizure reduction and the remaining third have no detectable clinical improvement.[69]


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