Surgery for temporal lobe epilepsy in the elderly: Improving quality of life despite cognitive impairment

Daniel Delev; Julia Taube; Christoph Helmstaedter; Karlijn Hakvoort; Alexander Grote; Hans Clusmann; Marec von Lehe

doi:10.1016/j.seizure.2020.05.003

Surgery for temporal lobe epilepsy in the elderly: Improving quality of life despite cognitive impairment

Seizure. 2020 Jul:79:112-119. doi: 10.1016/j.seizure.2020.05.003. Epub 2020 May 11.

Authors

Daniel Delev¹, Julia Taube², Christoph Helmstaedter², Karlijn Hakvoort³, Alexander Grote⁴, Hans Clusmann³, Marec von Lehe⁵

Affiliations

¹ Department of Neurosurgery, RWTH Aachen University, Aachen, Germany. Electronic address: ddelev@ukaachen.de.
² Dept. of Epileptology, University of Bonn Medical Center, Bonn, Germany.
³ Department of Neurosurgery, RWTH Aachen University, Aachen, Germany.
⁴ Clinic for Neurosurgery, Evangelic Hospital of Bethel, Bielefeld, Germany.
⁵ Department of Neurosurgery, Ruppiner Kliniken, Brandenburg Medical School, Neuruppin, Germany; Medical Faculty, University of Bonn Medical Center, Bonn, Germany.

PMID: 32464533
DOI: 10.1016/j.seizure.2020.05.003

Abstract

Introduction: Temporal lobe epilepsy (TLE) surgery is still underutilized, especially in the elderly population because of concerns related to postoperative complication rate and cognitive deterioration. The aim of the study was to evaluate surgical data, quality of life and neuropsychological outcome in elderly patients, who underwent resective surgery for drug resistant TLE.

Methods and materials: All patients underwent standardized presurgical assessment including clinical, neuroradiological, neuropsychological, and EEG examination. Elderly were considered all patients being 50 years or above (mean 56 yr., range 50-71 yr.). Neuropsychology was assessed before and after surgery, health-related quality of life (HRQOL) only after surgery.

Results: A total of 94 consecutive elderly patients were analyzed. Temporo-mesial resections were performed in 85 patients (90 %). Seizure outcome was available in all patients with a mean follow-up of 5.2 years (1.2-19 ± 3.75 years). 57 patients (60.6 %) were completely seizure free (ILAE 1). The overall morbidity was 10 % including 5 surgical complications and 5 permanent neurological deficits. Neuropsychological assessments in 60 patients showed considerable preoperative impairment, losses in different domains in 25-45 % and gains in about 25 % of the patients. Postoperative HRQOL data was available in 75 patients, revealing significant increase of HRQOL in all domains. Complete seizure freedom was the strongest predictor for postoperative HRQOL (p < 0.001).

Conclusion: Surgery for drug resistant temporal lobe epilepsy is a feasible option for elderly patients as seizure control rates are comparable to the younger population. The acceptable rate of permanent neurological deficits and relevant improvements in quality of life, despite considerable postoperative cognitive impairment, justify surgical resection in properly selected elderly patients.

Keywords: Elderly; Epilepsy surgery; HRQOL; Neuropsychology; Outcome.

MeSH terms

Aged
Cognitive Dysfunction* / etiology
Drug Resistant Epilepsy / surgery*
Epilepsy, Temporal Lobe / surgery*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neurosurgical Procedures* / adverse effects
Outcome Assessment, Health Care*
Quality of Life*