Division of Neurosurgery, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand.
Seizure. 2011 May;20(4):276-9. doi: 10.1016/j.seizure.2010.12.008. Epub 2011 Jan 8.
Patients of 50 years or older account for a small but significant portion of the patient population that receives surgical treatment for epilepsy. There have been few studies reporting surgical outcomes from temporal lobectomy in older patients. We examined seizure outcome and surgical complications after anterior temporal lobectomy for temporal lobe epilepsy with pathological evidence of unilateral hippocampal sclerosis. Two patient groups were compared in this study: patients 50 years or older (mean age 55.5 years old, n=16) and patients less than 50 years old (mean age 32.9 years old, n=184). After a minimum of one year follow up, younger patients (79.4%, n=146) were significantly more likely to be seizure-free (p=0.041) compared to older patients (56.3%, n=9). There was no significant difference (p=0.404) between the two age groups in the percentage of patients withdrawn from medication following surgery. Surgical complications were significantly higher in the older age group compared to the younger age group (p=0.009), although there was no permanent morbidity. Thus, while surgical treatment of temporal lobe epilepsy with unilateral hippocampal sclerosis is still beneficial in older patients who are refractory to medical therapy, surgical treatment should be considered at as early an age as possible, to maximize the chance for a better outcome with fewer complications.
50 岁或以上的患者在接受手术治疗癫痫的患者群体中占比较小但意义重大。仅有少数研究报告了老年患者行颞叶切除术的手术结果。我们研究了单侧海马硬化的颞叶癫痫行前颞叶切除术的癫痫发作结果和手术并发症。本研究比较了两组患者：50 岁或以上的患者（平均年龄 55.5 岁，n=16）和小于 50 岁的患者（平均年龄 32.9 岁，n=184）。随访至少 1 年后，年轻患者（79.4%，n=146）无癫痫发作的比例明显高于老年患者（56.3%，n=9）（p=0.041）。两组患者手术后停药的比例无显著差异（p=0.404）。与年轻年龄组相比，老年年龄组的手术并发症发生率显著更高（p=0.009），尽管没有永久性发病率。因此，虽然对于药物治疗无效的老年患者来说，单侧海马硬化的颞叶癫痫的手术治疗仍然有益，但应尽早进行手术治疗，以最大限度地提高更好的结果和更少并发症的机会。
