Epilepsy surgery for drug-resistant temporal lobe epilepsy in over-50 year-olds: Seizure outcome, surgical complications and neuropsychological outcome

Objective. - Surgery is an effective treatment for drug-resistant temporal-lobe epilepsy (TLE), but is still underutilized for older patients because of a perceived higher rate of perioperative complications, cognitive decline and worse seizure outcome.Methods. - We retrospectively screened all patients operated on in our institution for drug-resistant TLE between 2007 and 2019. Data of patients aged >= 50 years versus < 50 years at surgery were compared. The primary endpoint was freedom from disabling seizure (Engel I) at 2 years postoperatively.Results. - In patients aged >= 50 years (n = 19), mean age at surgery was 54.9 years and mean disease duration was 36.6 years. At 2 years postoperatively, rates of Engel I seizure outcome were not signifi-cantly different between the two groups (73.9% in the < 50 years group versus 94.4% in the >= 50 years group). Although surgical complications were significantly (47.4%) in the older patients, neurological deficit was permanent in only 5.3% of cases. At 1 year postoperatively, neuropsychological outcome did not significantly differ between the two groups.Conclusions. - Patients aged >= 50 years had an excellent seizure outcome at 2 years postoperatively. Early postoperative complications were more frequent in patients aged >= 50 years but were mostly transient. Cognitive outcome was similar to that in younger patients. These findings strongly suggest that age >= 50 years should not be an exclusion criterion for resective epilepsy surgery in patients with drug-resistant TLE.(c) 2022 Elsevier Masson SAS. All rights reserved.