Seize the Day or Let It Slip Away? The Dilemma of Epilepsy Surgery in Older Adults

Role of Comorbidities in Epilepsy Surgery Outcomes of Older Adults Tsai C, Taylor S, Thompson N, Vegh D, Bingaman W, Jehi L, Punia V. Epilepsia . 2024. doi:10.1111/epi.18103, PMID: 39283622. 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 post-surgical 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.