Role of comorbidities in epilepsy surgery outcomes of older adults.

IF 6.6 1区 医学 Q1 CLINICAL NEUROLOGY Epilepsia Pub Date : 2024-09-16 DOI:10.1111/epi.18103
Carolyn Tsai, Sara Taylor, Nicolas Thompson, Deborah Vegh, William Bingaman, Lara Jehi, Vineet Punia
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Abstract

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.

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合并症对老年人癫痫手术疗效的影响。
我们对老年人(≥60 岁)癫痫切除手术(RES)的预后因素缺乏了解,尤其是合并症的作用,而合并症是癫痫患者(PWE)护理管理中的一个主要考虑因素。我们分析了单中心队列中的 94 名老年人(中位年龄 = 63.5 岁,52% 为女性),他们在 2000 年至 2021 年期间接受了 RES 手术,术后随访至少 6 个月。研究队列中有四分之三的人有病变磁共振成像,并接受了颞叶切除术。54名(57%)PWE患者在中位随访3.5年期间没有癫痫发作。Cox 比例危险多变量分析显示,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 综合评分进行的敏感性分析(HR = 1.38,95% CI = 1.03-1.84,p = .027)证实了合并症与较差的癫痫发作预后相关。我们的研究结果为更好地讨论老年人的 RES 预后提供了一个框架。需要更广泛的多中心队列研究来验证我们的发现,并减少合适的老年人在寻求 RES 时的犹豫不决。
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来源期刊
Epilepsia
Epilepsia 医学-临床神经学
CiteScore
10.90
自引率
10.70%
发文量
319
审稿时长
2-4 weeks
期刊介绍: Epilepsia is the leading, authoritative source for innovative clinical and basic science research for all aspects of epilepsy and seizures. In addition, Epilepsia publishes critical reviews, opinion pieces, and guidelines that foster understanding and aim to improve the diagnosis and treatment of people with seizures and epilepsy.
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