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Histopathologic substrate of drug-resistant epilepsy in older adults and the elderly undergoing surgery.

ABSTRACT: Patients 60 years or older are one of the highest risk age groups for development of epilepsy. Clinical and neuroimaging analysis has typically accounted for etiology in two-thirds of these patients, while the data on histopathology are lacking. We provide the first analysis of the histopathological substrates underlying drug-resistant epilepsy (DRE) in older adults/elderly patients who underwent resective epilepsy surgery (RES) at Cleveland Clinic. A total of 78 patients (mean age ± standard deviation: 64.7 ± 3.7 years; 59% female) were included in the study. The most common pathologies included hippocampal sclerosis (HS; 35.9%; all visible on magnetic resonance imaging [MRI]), focal cortical dysplasia (FCD; 25.6%) and remote infarct/ischemic changes (12.8%). Underlying pathology did not differ significantly between the patients achieving a good seizure outcome (Engel class I; 77% [47 of 61 patients]) and the rest of the cohort. With one exception, all MRI-negative cases had FCD type Ib. A receiver-operating characteristic (ROC) curve analysis found a significant association (P = 0.002) between seizure-onset age and HS, whereby the odds of its presence were reduced by 4% for every 1 year increase in the age at seizure onset. The model showed that the age cutoff for seizure onset predicting HS was 43 years, with a negative predictive value of 81.6%. None of the 14 patients with late-onset epilepsy (?60 years of age) were found to have HS; they mostly had acquired lesions. Our study provides histopathologic evidence for the diminished role of late-onset HS in DRE in older adults/elderly who undergo RES.

SUBMITTER: Punia V

PROVIDER: S-EPMC6546012 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Histopathologic substrate of drug-resistant epilepsy in older adults and the elderly undergoing surgery.

Punia Vineet V Bena James J Gonzalez-Martinez Jorge J Bingaman William W Najm Imad I Stojic Andrey A Prayson Richard R

Epilepsia open 20190228 2

Patients 60 years or older are one of the highest risk age groups for development of epilepsy. Clinical and neuroimaging analysis has typically accounted for etiology in two-thirds of these patients, while the data on histopathology are lacking. We provide the first analysis of the histopathological substrates underlying drug-resistant epilepsy (DRE) in older adults/elderly patients who underwent resective epilepsy surgery (RES) at Cleveland Clinic. A total of 78 patients (mean age ± standard de ...[more]

PMID: 31168500

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Project description:ObjectivesValued life activities are those activities an individual deems particularly important or meaningful. Surgery in older adults can affect their ability to perform valued activities, but data are lacking. We characterized these activities and assessed performance of them following surgery.DesignRetrospective observational study.SettingPreoperative program for older adults undergoing elective surgery at an academic hospital.ParticipantsOlder adults (N = 194) in the program from February 2015 to February 2018.MeasurementsA preoperative written questionnaire asked, "What are the activities that are most important to you to be able to do when you return home from surgery?" Participants could list up to three activities. Content analysis was used to develop domains of valued life activities and categorize responses. Postoperative questionnaires and medical records were used to determine ability to perform activities 6 months after surgery.ResultsOf 194 participants (mean age = 74.9 ± 9.1 y), 57.7% were female; 33.5% had more than two comorbid conditions. We elicited 510 valued activities, with a mean of 2.6 (± .7) activities per participant. Content analysis revealed five categories: (1) recreational activities (28.9%); (2) mobility (24.9%); (3) activities of daily living (ADLs; 17.5%); (4) instrumental activities of daily living (IADLs; 16.9%); and (5) social activities (12.0%). Ultimately, 154 participants had surgery, of which 27.3% were unable to perform one of their valued activities at 6 months. Performance varied between activity categories; 91.9% of mobility activities, 90.8% of ADLs, 80.3% of IADLs, 77.3% of social activities, and 65.5% of recreational activities were able to be performed after surgery.ConclusionOlder adults expressed a wide range of valued life activities. More than one-quarter were unable to engage in at least one valued life activity after surgery, with recreation the most commonly affected. Assessment of valued life activities should be incorporated into the perioperative management of older adults. J Am Geriatr Soc 67:2305-2310, 2019.

Project description:ObjectiveTo evaluate the effectiveness of frontal disconnection surgery in seizure control and related consequences in a consecutive patient series.MethodsWe conducted a retrospective analysis of patients who underwent frontal disconnection surgery for drug-resistant epilepsy (DRE). Baseline epilepsy characteristics, detailed presurgical evaluation including epileptogenic zone (EZ) localization, magnetic resonance imaging (MRI) detection of epileptogenic lesion, and pathological findings were reviewed. Patients were followed postoperatively for seizure outcome at 1 year.ResultsA total of 16 patients were identified (six children and 10 adults). Most patients had a childhood onset of DRE with a median duration of epilepsy of 6.5 years (interquartile range 3.5-17.5 years) before surgery. In 10 (62.5%) patients, the EZ was localized to the frontal lobe, while in six patients, the EZ involved also adjacent lobes or consisted of multiple foci. In 10 (62.5%) patients, an epileptogenic lesion was detected on presurgical MRI, four of which (40%) had all MRI abnormalities confined to the frontal lobe. Two-thirds of the patients (11/16; 68.8%) underwent isolated frontal disconnection procedure, while remaining patients had frontal disconnection combined with resection of an adjacent lobe. Of the 12 patients in whom biopsy was taken from the disconnected frontal lobe, six (50%) had pathology-proven focal cortical dysplasia. We observed surgical-related complications in three (18.8%) cases, neurological deficits in other three (18.8%) patients, and worsening cognitive abilities in one (6.3%) patient. Overall, eight (50%) patients became completely seizure-free (ILAE 1) at one-year follow-up.SignificanceFrontal disconnection surgery for DRE can result in seizure freedom in certain patients, especially when the EZ is strictly limited to the ipsilateral frontal region, and the MRI shows an epileptogenic lesion that is purely frontal in location. Frontal lobe disconnection procedure is safe and has a limited complication rate. However, further studies with larger patient population will yield more significance.

Dataset Information

Histopathologic substrate of drug-resistant epilepsy in older adults and the elderly undergoing surgery.

Publications

Histopathologic substrate of drug-resistant epilepsy in older adults and the elderly undergoing surgery.

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