Predictive factors of postoperative outcome in the elderly after resective epilepsy surgery |
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| Institution: | 1. Department of Clinical Neurosciences, Bordeaux University Hospital, Bordeaux, France;2. Department of Neurosurgery, Bordeaux University Hospital, Bordeaux, France;3. Clinical Neurophysiology and Epileptology Department, APHM, Timone Hospital, Marseille, France;4. 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;10. IMN, UMR CNRS 5293, University of Bordeaux, Bordeaux Neurocampus, Bordeaux, France;1. U1172 – LilNCog – Lille Neuroscience & Cognition, university Lille, 59000 Lille, France;2. Department of neurology, CHU Lille, 59000 Lille, France;3. Department of neuroradiology, CHU Lille, 59000 Lille, France;4. CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 – UMS 2014 – PLBS, university Lille, 59000 Lille, France;1. Service d’épidémiologie et de santé publique, CHU, 35000 Rennes, France;2. Équipe d’accueil 3279, centre d’études et de recherche sur les services de santé, Aix-Marseille Université, 13000 Marseille, France;3. Inserm, service de neurologie, Clinical Neuroscience Center CIC-P 1414, CHU, 35000 Rennes, France;4. Service d’épidémiologie, clinique du centre hospitalier universitaire and Clinical Investigation Center CIC 1433, 54000 Nancy, France;5. Clinique neurologique, CHU de Nantes, 44000 Nantes, France;6. Pôle de médecine physique et de rehabilitation Saint-Hélier, 35000 Rennes, France;7. Équipe d’accueil 4360 adaptation, mesure et évaluation en santé, approches interdisciplinaires, service de neurologie, université de Lorraine, CHU de Nancy, 54000 Nancy, France;8. Inserm, Clinical Neuroscience Centre, CIC-P 1414, Université de Rennes 1, 35000 Rennes, France;1. Service d’Epidémiologie et de Santé Publique du Centre Hospitalier Universitaire de Rennes, 35000, Rennes, France;2. France and Equipe d’Accueil 3279 Centre d’Etudes et de Recherche sur les Services de Santé et la Qualité de Vie, Aix Marseille Université, 13000 Marseille, France;3. Service de neurologie du Centre Hospitalier Universitaire de Rennes et Clinical Neuroscience Center CIC-P 1414 Inserm, 35000 Rennes, France;4. Équipe d’Accueil 4360 Adaptation, mesure et évaluation en santé, Approches interdisciplinaires, Université de Lorraine and Service de Neurologie du Centre Hospitalier Universitaire de Nancy, 54000 Nancy, France;5. Clinique Neurologique du Centre Hospitalier Universitaire de Nantes, 44000 Nantes, France;6. Pôle de médecine physique et de rehabilitation Saint Hélier, 35000 Rennes, France;7. Clinical Neuroscience Centre, CIC-P 1414 Inserm Université de Rennes 1, 35000 Rennes, France;1. Bordeaux University, 33076 Bordeaux, France;2. Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33600 Pessac, France;3. Bordeaux Cardio-Thoracic Research Center, U1045, Bordeaux University, 33076 Bordeaux, France;4. Endocrinology-Metabolic Diseases, Hôpital Saint-Andre, Bordeaux University, 33076 Bordeaux, France;5. Biochemistry Laboratory, Hôpital Cardiologique du Haut-Lévêque, Bordeaux University, 33600 Pessac, France;6. Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, CNRS/Bordeaux University, 33000 Bordeaux, France;7. Stroke Unit, Bordeaux University Hospital, Hôpital Pellegrin, 33076 Bordeaux, France;8. Interventional Neuroradiology Department, Bordeaux University Hospital, 33076 Bordeaux, France;9. UMR 5287 CNRS, Bordeaux University, EPHE PSL Research University, 33076 Bordeaux, France;1. Department of Radiology, Bichat University Hospital, AP–HP, 75018 Paris, France;2. Inserm U1148, University Paris, Paris, France |
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| Abstract: | ObjectiveTo evaluate the efficiency of resective epilepsy surgery (RES) in patients over 50 years and determine prognostic factors.ResultsOver 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.ConclusionsRES 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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| Keywords: | Epilepsy surgery Elderly Drug-resistant epilepsy Lobectomy |
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