Resective surgery for mesial temporal lobe epilepsy associated with hippocampal sclerosis in patients over 50 years: a case-control study.

Cognitive outcome Complications Elderly Epilepsy surgery Seizure outcome Selective amygdalohippocampectomy

Journal

Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161

Informations de publication

Date de publication:
29 Jul 2024
Historique:
received: 12 05 2024
accepted: 20 07 2024
revised: 11 07 2024
medline: 29 7 2024
pubmed: 29 7 2024
entrez: 28 7 2024
Statut: aheadofprint

Résumé

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. 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. 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). 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.

Sections du résumé

BACKGROUND 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 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 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 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.

Identifiants

DOI: 10.1007/s00415-024-12599-4 PMID: 39069564
pubmed: 39069564
doi: 10.1007/s00415-024-12599-4
pii: 10.1007/s00415-024-12599-4
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.

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Auteurs

Marta Garvayo (M)

Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France.

Sophie Dupont (S)

Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France.

Valerio Frazzini (V)

Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France.
Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France.

Franck Bielle (F)

Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France.
Department of Neuropathology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France.

Claude Adam (C)

Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France.

Yahia El Bendary (YE)

Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France.

Marie Méré (M)

Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France.

Séverine Samson (S)

Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France.
ULR 4072 - PSITEC, University of Lille, Lille, France.
Institut Pasteur, INSERM, Institut de l'Audition, Université Paris Cité, Paris, France.

Alice Guesdon (A)

Department of Psychiatry, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France.

Vincent Navarro (V)

Department of Neurology, Epilepsy Unit, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France.
Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France.

Bertrand Mathon (B)

Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France. bertrand.mathon@aphp.fr.
Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, UMRS 1127, Sorbonne Université, Paris, France. bertrand.mathon@aphp.fr.
Sorbonne Université, GRC 23, Brain Machine Interface, APHP, Paris, France. bertrand.mathon@aphp.fr.
Robotics and Surgical Innovation, Sorbonne Université GRC 33, APHP, Paris, France. bertrand.mathon@aphp.fr.
ORCID: 0000-0002-9182-5846

Classifications MeSH