Predictive factors of postoperative outcome in the elderly after resective epilepsy surgery.
Revue Neurologique. 2021-11-01; :
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Thomas B(1), Aupy J(2), Penchet G(3), De Montaudouin M(1), Bartolomei F(4), Biraben A(5), Catenoix H(6), Chassoux F(7), Dupont S(8), Valton L(9), Michel V(1), Marchal C(1).
(1)Department of Clinical Neurosciences, Bordeaux University Hospital, Bordeaux, France.
(2)Department of Clinical Neurosciences, Bordeaux University Hospital, Bordeaux, France; IMN, UMR CNRS 5293, University of Bordeaux, Bordeaux Neurocampus, Bordeaux, France. Electronic address: .
(3)Department of Neurosurgery, Bordeaux University Hospital, Bordeaux, France.
(4)Clinical Neurophysiology and Epileptology Department, APHM, Timone Hospital, Marseille, France; INS, Institut de Neurosciences des Systèmes, Aix-Marseille University, Marseille, France.
(5)Department of Neurology, University Hospital of Rennes, Rennes, France.
(6)Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France.
(7)Department of Neurosurgery, Sainte-Anne Hospital Centre, Paris, France.
(8)Epilepsy Unit, La Pitié-Salpêtrière University Hospital, AP-HP, Paris, France.
(9)Department of Neurology, Toulouse University Hospital, Toulouse, France.
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 outcome 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 neuropathological 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 associated with a poorer prognosis (P=0.001). Postoperative number of antiepileptic drugs was significantly 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 complication 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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