Of several thousand patients nationwide who have received surgical treatment for intractable epilepsy, probably only a handful have been older than age 50. Cascino et al83 reported at least worthwhile outcomes in every one of 8 patients aged 50 to 60 after temporal lobectomy, with 3 becoming seizure-free.
Many people with long-standing epilepsy have never been referred for evaluation for surgery and may be first identified as surgical candidates in old age. Increased risk of comorbidity and perioperative complications, as well as possibly decreased potential benefit from a successful outcome, should be considered. But despite these considerations, many patients may wish to pursue the possibility of living the rest of their lives with no or far fewer epileptic seizures.
When epilepsy is the result of an extratemporal lesion, the same issues apply. The likelihood of a progressive, histologically malignant lesion increases with age, however. In these cases the goal of resective surgery would be postponing disability and death rather than alleviating epilepsy.
Arguments about increased risk and decreased benefit are more salient when applied to extratemporal, nonlesional epilepsy. In most studies, the success rate for surgery has been lower than for temporal lobe epilepsy. A more demanding evaluation also is required, usually involving invasive monitoring.
Reviewed and revised June 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.
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