Medical Student National Institute of Neurology and Neurosurgery Mexico City, DF, MX
Introduction: Resective epilepsy surgery (RES) is the standard of care for lesional drug-resistant epilepsy. However, its efficacy and safety in older adults remain unclear, as most studies focus on younger populations. This meta-analysis aims to review the outcomes of RES in patients aged 60 and older, comparing them with a cohort of younger patients.
Methods: A comprehensive database search was conducted up to October 23rd, 2024, to identify studies reporting outcomes of RES in patients aged 60 and above (elderly), compared to a group of younger patients. Primary outcomes included seizure freedom (SF), postoperative complications, and both permanent and transient neurological deficits.
Results: Out of 1,050 articles, 9 retrospective cohort studies were included, analyzing 1,191 patients. Elderly patients showed a higher rate of SF compared to the younger patients (RR=1.18, 95%CI=1.03-1.36, p=0.02). However, elderly patients also experienced significantly higher rates of postoperative complications (RR=2.37, 95%CI=1.62-3.46, p= < 0.00001), and neurological deficits (RR=2.58, 95%CI=1.57-4.24, p=0.0002). This included both permanent neurological deficits (RR=4.31, 95%CI=1.85-10.03, p=0.0007), and transient neurological deficits (RR=2.15, 95%CI=1.01-4.59, p=0.05).
Conclusion : Elderly patients undergoing RES showed higher SF rates compared to younger patients, but also faced a significantly increased risk of complications and neurological deficits. The generalizability of our findings is limited by the diverse etiologies of drug-resistant epilepsy between groups. Multicentric comparative studies with matched populations are needed to better evaluate the benefits of RES in elderly patients, considering the high morbidity associated with permanent neurological deficits. These findings highlight the importance of thorough risk-benefit analysis and careful patient selection for elderly patients with epilepsy.
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