Resective surgery for mesial temporal lobe epilepsy associated with hippocampal sclerosis in patients over 50 years: a case–control study
Marta Garvayo, Sophie Dupont, Bertrand Mathon
Background
Mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE/HS) is the most common cause of drug-resistant focal seizures and surgical resection is the primary treatment option, with seizure-free rates ranging from 60 to 80%. However, data on postsurgical seizure outcomes in patients =/+50 years of age are limited. This study aimed to assess the efficacy and safety of surgery in this age group compared to younger patients.
Methods
We performed a retrospective analysis of data from resective surgeries conducted in patients with MTLE/HS between 1990 and 2022. We focused on patients aged =/+50 years and compared the surgical safety and efficacy variables between this group and a control group of patients aged <50 years through a case–control study.
Results
Among the 450 MTLE/HS patients who underwent surgery during the inclusion period, 61 (13.6%) were aged =/+50 years and matched with 183 younger patients, totaling 244 study participants. The two groups had similar characteristics. At the last follow-up (median 5.7 years), Engel I outcomes were achieved in 80.3% of the older patients and 81.4% of the younger patients, with no significant difference (p=0.85). Postoperative cognitive and psychiatric outcomes did not differ between the groups. Major complication rates were also comparable, at 3.3% in the older group and 2.7% in the younger group (p=0.83). The extratemporal ictal abnormalities observed on video-EEG were the only variable that demonstrated a significant association with an unfavorable seizure outcome in the older group (OR 9.3, 95% CI [1.8-47.6], p=0.005).
Conclusions
This study provides grade 3 evidence that resective surgery for MTLE/HS patients aged =/+50 years is as effective and safe as it is for younger patients, and thus should be considered as the primary treatment option for drug-resistant cases.