Resective epilepsy surgery in patients aged 50 years and older – a retrospective study regarding seizure outcome, memory performance, and psychopathology

Hebel, Jonas M.; Heerwig, Carina; Möller, Hendrik; Sauvigny, Thomas; Martens, Tobias; Dührsen, Lasse; Stodieck, Stefan; Brückner, Katja; Lanz, Michael

doi:10.1016/j.yebeh.2021.107933

Cited by 11 publications

(8 citation statements)

References 59 publications

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“…Longer duration of epilepsy is usually associated with a cumulatively higher number of anti-seizure medication (ASM) previously taken. For example, one of the authors of this paper reported a median of more than seven (between two and 14) ASM in a cohort of people over 50 years of age [26], whereas the median was three (0-10) in a cohort of adults of all ages [16].…”

Section: Authorsmentioning

confidence: 72%

“…Approximately 170 cases of patients older than 60 years can be identified from the aforementioned literature: 20 patients underwent extratemporal resections (11 frontal, three parietooccipital, and four multilobar), while the precise classification of two others remains unclear [14,34,41,42]. Finally, just under ten surgeries can be identified in patients over 70 years of age [14,26,40,41], of which only one patient underwent extratemporal RES-a perirolandic extended lesionectomy for meningioma [41]. In patients older than 50 years of age, ten cases of repeated resection in the absence of postoperative seizure freedom are mentioned [26,30,41].…”

Section: Authorsmentioning

confidence: 99%

“…Finally, just under ten surgeries can be identified in patients over 70 years of age [14,26,40,41], of which only one patient underwent extratemporal RES-a perirolandic extended lesionectomy for meningioma [41]. In patients older than 50 years of age, ten cases of repeated resection in the absence of postoperative seizure freedom are mentioned [26,30,41]. However, there are relatively large single-center series that address this issue separately, some of which also include "older" patients [21,23,44,55].…”

Section: Authorsmentioning

confidence: 99%

“…In addition, there have been publications describing an age-related poorer neuropsychological prognosis ( [39,50], see article by Heerwig et al in this issue). At the same time, there is a large number of studies that reported non-inferiority in older patients with respect to seizure freedom (including [22,26,34]), surgical complications [37,39,41], and cognitive effects [8,26].…”

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confidence: 99%

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Epilepsy surgery in older patients – English Version

Hebel

Holtkamp

2022

Z. Epileptol.

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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.

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Section: Authorsmentioning

confidence: 72%

Section: Authorsmentioning

confidence: 99%

Section: Authorsmentioning

confidence: 99%

mentioning

confidence: 99%

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Epilepsy surgery in older patients – English Version

Hebel

Holtkamp

2022

Z. Epileptol.

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“…These findings are consistent with the role of the amygdala in processing negative emotions and psychopathology, including symptoms of depression (Donegan et al ., 2003; Tranel et al ., 2007; Victor et al ., 2010). This builds on prior studies of mood outcomes following a medial temporal lobe resection (Spencer et al ., 2003; MacRodimitris et al ., 2011; Smith et al ., 2018; Bijanki et al ., 2020; Hebel et al ., 2021). To the best of our knowledge, this is the first study to investigate the effects of surgical resection of the amygdala on mood using a multivariate lesion symptom mapping method, which provides a data-driven approach for relating change in mood symptoms to specific medial temporal lobe structures that, when resected, are significantly associated with these changes.…”

Section: Discussionmentioning

confidence: 99%

Right amygdala lesions are associated with improved mood after epilepsy surgery

Albazron

Tranel

Howard

et al. 2022

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Neuroimaging studies in healthy and clinical populations strongly associate the amygdala with emotion, especially negative emotions. The consequences of surgical lesions of the amygdala on mood are not well characterized. We tested the hypothesis that amygdala lesions would result in mood improvement. In this study we evaluated a cohort of 52 individuals with medial temporal lobectomy for intractable epilepsy who had resections variably involving the amygdala. All individuals achieved good post-surgical seizure control and had pre- and post-surgery mood assessment with the Beck Depression Inventory (BDI) ratings. We manually segmented the surgical resection cavities and performed multivariate lesion-symptom mapping of change in BDI. Our results showed a significant improvement in average mood ratings from pre- to post-surgery across all patients. In partial support of our hypothesis, resection of the right amygdala was significantly associated with mood improvement (r = 0.5, p = 0.008). The lesion-symptom map also showed that resection of the right hippocampus and parahippocampal gyrus was associated with worsened post-surgical mood. Future studies could evaluate this finding prospectively in larger samples while including other neuropsychological outcome measures.

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