老年人癫痫手术的前景:挑战与机遇。

IF 2.8 3区 医学 Q2 CLINICAL NEUROLOGY
Epilepsia Open Pub Date : 2025-05-19 DOI:10.1002/epi4.70062
Vineet Punia
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引用次数: 0

摘要

癫痫的患病率随着年龄的增长而增加,随着人口的老龄化,耐药癫痫(DRE)病例的数量预计会增加。然而,癫痫手术仍未得到充分利用,通常提供给年轻人。尽管由于对风险和结果的担忧而存在历史上的犹豫,但过去20年的证据表明,老年人(≥50岁)的癫痫手术可以实现癫痫发作自由。老年人的癫痫发作结果与年轻人相当,一些研究表明60岁以上患者的癫痫发作自由率甚至更高。然而,对手术风险、认知能力下降和术后并发症的担忧仍然存在。接受癫痫手术的老年人有更高的合并症负担,这可能与较低的癫痫发作自由率和术后非家庭出院的可能性增加有关。此外,虚弱可以影响术后处置,尽管其对癫痫发作结果的影响尚不清楚。手术并发症在老年人中更为常见,语言障碍、梗死和硬膜下积液的发生率更高,这是老年人独有的问题。认知结果仍然不同,老年人言语记忆下降的风险更大,特别是在主半球切除后。然而,研究表明,手术后的生活质量得到改善,尤其是那些没有癫痫发作的患者。微创手术,如激光间质热疗法(LITT)和神经调节技术,如迷走神经刺激(VNS)和反应性神经刺激(RNS)为那些不适合切除手术的患者提供了有希望的选择。未来的研究将有助于改进患者选择,解决虚弱的影响,并探索长期结果。尽管存在风险,但年龄本身不应排除癫痫手术,个性化决策仍然是优化结果的关键。摘要:在我们快速老龄化的世界中,越来越多的老年人将患有耐药性癫痫。对于50岁以上的成年人来说,癫痫手术是一种安全有效的选择,在许多情况下,它们在消除癫痫方面的效果与年轻患者一样好。虽然并发症的风险略高,但这些风险应该与潜在的好处进行权衡。老年人通常有其他可能影响康复的健康问题。记忆和思维会发生变化,尤其是随着年龄的增长,但结果各不相同。年龄本身不应阻止某人接受手术。每个案例都值得仔细、个性化的评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The landscape of epilepsy surgery in older adults: Challenges and opportunities.

The prevalence of epilepsy increases with age, and with the aging population, the number of drug-resistant epilepsy (DRE) cases is expected to rise. However, epilepsy surgery remains underutilized and is typically offered to younger adults. Despite historical hesitancy due to concerns over risks and outcomes, evidence over the last two decades shows that epilepsy surgery in older adults (≥50 years) can achieve seizure freedom. Seizure outcomes in older adults are comparable to those in younger adults, with some studies indicating even higher seizure freedom rates in patients over 60. However, concerns persist regarding surgical risks, cognitive decline, and postoperative complications. Older adults undergoing epilepsy surgery have a higher comorbidity burden, which may be associated with lower seizure freedom rates and an increased likelihood of non-home discharge post-surgery. Additionally, frailty can influence post-surgical disposition, although its impact on seizure outcome remains unclear. Surgical complications are more common in older adults, with a higher incidence of language disturbances, infarctions, and subdural hygromas-an issue exclusively observed in this population. Cognitive outcomes remain heterogeneous, with older adults at greater risk of verbal memory decline, particularly after dominant hemisphere resections. However, studies indicate that quality of life improves after surgery, particularly in patients with seizure freedom. Minimally invasive procedures such as laser interstitial thermal therapy (LITT) and neuromodulation techniques like vagus nerve stimulation (VNS) and responsive neurostimulation (RNS) offer promising alternatives for those who are not ideal candidates for resective surgery. Future research will help refine patient selection, address the impact of frailty, and explore long-term outcomes. Despite the risks, age alone should not preclude epilepsy surgery, and individualized decision-making remains key to optimizing outcomes. PLAIN LANGUAGE SUMMARY: In our rapidly aging world, an increasing number of older adults will have drug-resistant epilepsy. Epilepsy surgery can be a safe and effective option for adults over 50, and in many cases, they do just as well as younger patients in becoming seizure-free. While there is a slightly higher risk of complications, these risks should be weighed against the potential benefits. Older adults often have other health issues that may affect recovery. Memory and thinking changes can happen, especially with age, but outcomes vary. Age alone should not prevent someone from being considered for surgery. Each case deserves careful, personalized evaluation.

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来源期刊
Epilepsia Open
Epilepsia Open Medicine-Neurology (clinical)
CiteScore
4.40
自引率
6.70%
发文量
104
审稿时长
8 weeks
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