Epilepsy surgery in older patients – English Version

Abstract

Removal of the seizure focus, either by resection or by laser thermal ablation, has a high chance to result in seizure freedom in well-selected patients with focal drug-resistant epilepsy. Vagus nerve stimulation and deep brain stimulation are palliative approaches, which aim to reduce the number and severity of epileptic seizures. In older patients there seems to be an overall reluctance with respect to all epilepsy surgery procedures. In this context, "older" means patients with an age of 50 years and above. In this article, we assess if there are clinically relevant differences with respect to seizure outcome and complications in older patients compared to younger patients when using the different epilepsy surgery approaches. Overall, available and reliable data are sparse and there are hardly any studies of high quality. Most data with almost 700 patients are on resective surgery, predominantly from retrospective monocentric studies on temporal lobe epilepsy. In summary, it seems that the rates of seizure freedom and complications do not differ significantly in older patients compared to younger patients; however, it cannot be ruled out that in the group of older patients rather clear and straightforward cases have been resected. For thermal ablation procedures, no specific data on older patients exist. The minimally invasive approach with few complications, however, may be interesting particularly for older patients. With respect to vagus nerve stimulation and deep brain stimulation, the available data do not give any evidence for differences in efficacy and safety in older vs. younger patients.