Spectrum Health Study Shows Surgery May Be Effective Treatment Option for Older Epilepsy Patients

A recently published study by researchers from Spectrum Health and Henry Ford Hospital suggests that surgery may be an effective treatment for epilepsy in older patients, a finding that runs counter to conventional treatment methods.

"Traditionally, there has been a tendency to exclude older patients from surgery for fear of increased risk of medical or surgical complications," said Spectrum Health Medical Group neurosurgeon Sanjay Patra, MD, lead author of the study. "This study provides evidence that surgery may instead be a viable and effective treatment option."

The study, recently published online in the British Journal of Neurosurgery, uses a retrospective institutional archival review of 122 Henry Ford Hospital patients with medically refractory partial epilepsy. Medically refractory seizures are those that do not respond successfully to drug treatment. Partial epilepsy refers to a type of seizure that originates and remains in a limited area of the brain, such as the temporal lobe.

Researchers compared surgical outcomes of a group of patients aged 50 years and older with those of a younger group of patients. The median follow-up time for both the younger and older groups was 24 months. Results showed that 74 percent of patients in the older group remained free of disabling seizures compared with 58 percent of patients in the younger group. Among patients aged 60 years or older, 91 percent remained seizure-free.

All patients underwent surgery during a 15-year period between 1993 and 2008, and were operated on by Kost Elisevich, MD, PhD, neurosurgeon, co-chair department of clinical neurosciences, chief, division of neurosurgery, Spectrum Health Medical Group, and senior author of the study.

"Patients were distinguished by age and brain location of surgery to establish whether older patients experienced less optimal outcomes regarding seizure cessation, memory, cognition, likelihood of complications and whether surgery location factored significantly in these outcome measures," Dr. Elisevich said.

Surgery for Seizures & Epilepsy

Many people consider surgery - especially brain surgery - as the last alternative if all other treatment methods are not effective. In reality, surgery should be among the first options considered if early trials with anticonvulsant medications are ineffective.

If seizures occur in one area of the brain, and that area can be removed easily and without causing other problems, surgery should be considered. If epilepsy is caused by a tumor, cyst, lesion or other growth that won’t respond well to medication, your physician can help patients decide if surgery is an appropriate option. Take a look at the following four questions:

Is the child or adult having seizures?
Are these seizures often and difficult to control?If you answer yes to these four questions, you should obtain more information. It is important to note that except in the rare instance of a rapidly growing brain tumor, epilepsy surgery is not usually an emergency – it should only be done after careful consideration of the risks and benefits of the surgery.