Neurological Institute, Cleveland Clinic Epilepsy Center, Cleveland, Ohio, USA.
Department of Quantitative Health Sciences, Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
Epilepsia. 2024 Nov;65(11):e190-e196. doi: 10.1111/epi.18103. Epub 2024 Sep 16.
We lack knowledge about prognostic factors of resective epilepsy surgery (RES) in older adults (≥60 years), especially the role of comorbidities, which are a major consideration in managing the care of people with epilepsy (PWE). We analyzed a single-center cohort of 94 older adults (median age = 63.5 years, 52% females) who underwent RES between 2000 and 2021 with at least 6 months of postsurgical follow-up. Three fourths of the study cohort had lesional magnetic resonance imaging and underwent temporal lobectomy. Fifty-four (57%) PWE remained seizure-free during a median follow-up of 3.5 years. Cox proportional hazard multivariable analysis showed that aura (hazard ratio [HR] = .52, 95% confidence interval [CI] = .27-1.00), single ictal electroencephalographic pattern (HR = .33, 95% CI = .17-.660), and Elixhauser Comorbidity Index (HR = 1.05, 95% CI = 1.00-1.10) were independently associated with seizure recurrence at last follow-up. A sensitivity analysis using the Charlson Combined Score (HR = 1.38, 95% CI = 1.03-1.84, p = .027) confirmed the association of comorbidities with worse seizure outcome. Our findings provide a framework for a better informed discussion about RES prognosis in older adults. More extensive, multicenter cohort studies are needed to validate our findings and reduce hesitancy in pursuing RES in suitable older adults.
我们对老年人（≥60 岁）的可切除性癫痫手术（RES）的预后因素知之甚少，尤其是合并症的作用，这是管理癫痫患者（PWE）护理的主要考虑因素。我们分析了 2000 年至 2021 年间在我们单中心进行 RES 的 94 例老年患者（中位年龄 63.5 岁，52%为女性）的队列，这些患者至少有 6 个月的术后随访。研究队列中有四分之三的患者有病变性磁共振成像，并接受了颞叶切除术。在中位随访 3.5 年期间，54 例（57%）患者无癫痫发作。Cox 比例风险多变量分析显示，先兆（危险比 [HR] =.52，95%置信区间 [CI] =.27-1.00）、单一发作性脑电图模式（HR =.33，95% CI =.17-.660）和 Elixhauser 合并症指数（HR = 1.05，95% CI = 1.00-1.10）与最后一次随访时的癫痫复发独立相关。使用 Charlson 合并症评分（HR = 1.38，95% CI = 1.03-1.84，p =.027）进行的敏感性分析证实了合并症与癫痫结局恶化的关联。我们的研究结果为更好地讨论老年人 RES 的预后提供了框架。需要更广泛的多中心队列研究来验证我们的发现，并减少在合适的老年人中进行 RES 的犹豫。
