Bialek Fatima, Rydenhag Bertil, Flink Roland, Malmgren Kristina
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
Department of Clinical Neurophysiology, Akademiska University Hospital, Uppsala, Sweden.
Seizure. 2014 Sep;23(8):641-5. doi: 10.1016/j.seizure.2014.05.003. Epub 2014 May 13.
Most epilepsy surgery candidates are young adults. Outcome reports after epilepsy surgery in patients ≥50 years are few and varying. The aim of this study was to describe patient characteristics of older compared to younger adults and analyse seizure, complication and vocational outcomes in a large population-based series.
We analysed data from the Swedish National Epilepsy Surgery Register for 1990-2009 for patients ≥19 years at resective surgery who had completed two-year follow-up. Variables studied were seizure outcome, histo-pathological diagnoses, complications and vocational outcome. Data from patients ≥50 years and 19-49 years at surgery were compared.
558 Adults underwent resective epilepsy surgery 1990-2009 and had two-year follow-up. 12% of the adults (67 patients) were ≥50 years at surgery. Patients ≥50 had longer epilepsy duration, more often had mesial sclerosis and less often had neurodevelopmental tumours and cortical malformations. The proportion of seizure-free patients at two-year follow-up did not differ between those ≥50 and 19-49 years (61% versus 61% seizure-free last year, 48% versus 43% completely seizure-free since surgery), neither did the occurrence of major complications (3% in both groups). The vocational situation was mainly stable between baseline and two-year follow-up in both groups, although older patients were less often employed than younger.
12% of adults in the Swedish series were ≥50 years at epilepsy surgery. Seizure outcome was as good for older as for younger adults, and there was no difference in the occurrence of major complications. This constitutes important information in the presurgical counselling process.
大多数癫痫手术候选者为年轻成年人。关于≥50岁患者癫痫手术后的结果报告较少且各不相同。本研究的目的是描述老年患者与年轻成年人相比的患者特征，并分析一个基于人群的大型系列中的癫痫发作、并发症及职业结局。
我们分析了瑞典国家癫痫手术登记处1990 - 2009年的数据，纳入了接受切除性手术且年龄≥19岁并完成两年随访的患者。研究变量包括癫痫发作结局、组织病理学诊断、并发症及职业结局。对手术时年龄≥50岁和19 - 49岁患者的数据进行了比较。
1990 - 2009年间，558名成年人接受了切除性癫痫手术并进行了两年随访。其中12%的成年人（67例患者）手术时年龄≥50岁。≥50岁的患者癫痫病程更长，更常患有内侧颞叶硬化，较少患有神经发育性肿瘤和皮质发育畸形。在两年随访时，≥50岁组与19 - 49岁组无癫痫发作患者的比例无差异（去年无癫痫发作的比例分别为61%和61%，自手术以来完全无癫痫发作的比例分别为48%和43%），主要并发症的发生率也无差异（两组均为3%）。两组患者从基线到两年随访期间职业状况基本稳定，不过老年患者就业的比例低于年轻患者。
在瑞典的该系列研究中，12%的成年癫痫手术患者年龄≥50岁。老年患者与年轻成年人的癫痫发作结局一样好，主要并发症的发生率也无差异。这在术前咨询过程中是重要信息。
