WASHINGTON, DC — Despite the prevailing view that resective epilepsy surgery is best done on young adults, older patients who undergo this procedure have an excellent outcome, according to a small new study.
Results showed that patients over age 60 years did well after surgery in terms of seizure freedom, despite having 1 or more comorbid condition, and they had improved quality of life.
The results, presented at the American Epilepsy Society (AES) 67th Annual Meeting, illustrate that as the population ages and more older people are developing epilepsy, chronologic age should not be a barrier to access epilepsy surgery.
"This drives home the point that in all populations — not just children and younger adults, but in older adults — this type of intervention can be life changing; that it not only can take away seizures that rob people of the ability to have independence, to potentially work if they want to, and to drive, but can have a lot of impact on other spheres of health," said Brian Moseley, MD, instructor in neurology, University of California at Los Angeles (UCLA).
"We shouldn't be dissuaded by things such as patient age and having other medical problems."
For the study, researchers searched the UCLA surgery database to identify patients aged 60 years and over who had undergone epilepsy surgery between 1992 and 2012 and had at least 1 year of follow-up.
The study included 10 patients, aged 60 to 74 years, with an average age at epilepsy diagnosis of 37 years who had experienced seizures for an average of 27 years, although one older woman had been diagnosed only for 3 years. About 70% of the patients had at least 1 other medical comorbid condition, such as hypertension or diabetes.
The study showed that 70% of these older patients were rendered completely seizure free after their surgery (Engel class 1) and 90% were either completely seizure free or only had rare seizures (Engel 1 or 2), Dr. Moseley reported.
From telephone interviews with 9 patients (1 died of a brain tumor that had caused the seizures), researchers determined that having surgery was associated with improvements in quality of life. About 75% of the patients reported excellent life satisfaction, and about a third had improvements in domains of health other than postsurgery seizures, said Dr. Moseley.
Being married and feeling socially connected seemed to contribute to better life satisfaction scores, he said.
Although the older age group "is a very understudied population," what research there is shows that "there really isn't an upper age limit" when it comes to epilepsy surgery, said Sandra Dewar, RN, lead author of the study.
Many experts believe the best age for epilepsy surgery is 15 to 30 years, said Dewar. The current study goes a long way toward dispelling this and other "misconceptions" associated with older people getting epilepsy surgery, she said.
For example, the prevailing opinion is that older people with epilepsy have too many other illnesses for surgery to be safe. Another misconception is that all older people with epilepsy have had the disease for several years and so having surgery would have little effect on their quality of life.
"We found that in our study that those things are incorrect," said Dewar.
She pointed out that life satisfaction and disability should be measured differently in older people, who may no longer be working or driving a car.
She also noted the "trend" they are seeing of more older people coming to the UCLA epilepsy center, and likely other similar centers.
Asked for comment on these findings, Dawn Eliashiv, MD, professor of neurology and co-director, Seizure Disorder Center, UCLA, said the "take-home message" from this study is that resective epilepsy surgery is a good option in older patients. "I think it's remarkable that 90% had Engel class 1and 2," she said.
Marianna V. Spanaki, MD, PhD, a neurologist at the Henry Ford Epilepsy Program, Detroit, said in her view, it helps illustrate the need to refer patients with epilepsy for surgery.
Dr. Spanaki pointed out that the Institute of Medicine report of 2011 estimated that only 3000 to 4000 epilepsy surgeries are carried out every year while 100,000 to 200,000 people with epilepsy are candidates for such surgery.
"This means that epilepsy surgery is very much underutilized," said Dr. Spanaki. "Many people who could benefit at least deserve a surgical evaluation."
American Epilepsy Society (AES) 67th Annual Meeting. Abstract 3.252. Presented December 8, 2013.
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Cite this: Older Epilepsy Patients Have Good Surgical Outcomes - Medscape - Dec 10, 2013.