Surgery beneficial to select older adults with epilepsy

Epilepsy surgery may hold promise for carefully selected patients past the age of 50 years, according to a study.

Researchers conducted a systematic review and meta-analysis of studies wherein the efficacy and safety of epilepsy surgery in adults 50 years of age and older. Inclusion criteria included having a minimum of 10 participants and 6 months of follow-up.

Multiple online databases were searched for relevant literature. Two reviewers assessed the risk of bias of each included study using the MINORS (Methodological Index for Non-Randomized Studies) instrument.

The meta-analysis included 11 case series and 14 cohort studies, with the total population comprising 1,111 older adults who underwent epilepsy surgery and 4,111 adults younger than 50 years (control).

Pooled data showed that resective surgery led to seizure freedom in most of older adults, with a cumulative incidence of 70.1 percent (95 percent confidence interval [CI], 65.3–74.7). The incidence of seizure freedom among older adults was not significantly different from that among younger adults (risk ratio [RR], 1.05, 95 percent CI, 0.97–1.14) in cohort studies.

Meanwhile, perioperative complications occurred in 26.2 percent (95 percent CI, 21.3–31.7) of older adults. Of these, 7.5 percent (95 percent CI, 5.8–9.5) had major complications. Older age was significantly associated with experiencing any complication compared with younger age (risk ratio, 2.8, 95 percent CI, 1.5–5.4).