Though not appropriate for everyone, surgery for epilepsy can be a very effective treatment. It is being used increasingly, especially in children and adolescents. This study specifically looked at success rates for surgery in patients aged more than 50 years. Adult brains cannot reorganise themselves as young children's brains can, and do not repair themselves as quickly. Adults are likely also to have had epilepsy for much longer than children have, and to have different underlying causes for their epilepsy. The study aimed to find out whether factors such as these made a difference to the success of the operation.

Dr Grivas and colleagues at the University of Bonn Medical Centre, Germany, looked at fifty-two patients with temporal lobe epilepsy, aged on average 55 years at the time of the operation, who had surgery to control their epilepsy between 1991 and 2002. All had epilepsy that would not respond to anti-epileptic drugs which, at the time of their operation, had lasted an average of 33 years. The results were compared with those of a younger group of patients operated on in the same time period.

Seventy-one percent of patients achieved complete seizure freedom after their operation, with a further 19% having only rare seizures. In a subgroup of patients aged more than 60 years at the time of surgery, the same rate of success was seen. These rates did not differ significantly from that in the group of younger patients.

The patients with the best chance of a good result appeared to be those with the shortest duration of epilepsy (less than 30 years) and with fewer than five seizures per month. Though no patient died due to the operation, five patients had complications due to the surgery (including partial paralysis and partial loss of vision), which is a higher proportion than in younger patients.

The researchers, writing in the journal Epilepsia in August, concluded that surgery to control intractable epilepsy was promising in older patients, despite their having had seizures for several decades. The risk of complications after surgery is higher than in younger patients, but this is to be expected. Overall, this is encouraging news for patients, that even after 30 years with seizures, surgery can be an effective and safe treatment option.

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