Abstract: Objective To investigate the seizure characteristics and the efficacy and safety of surgical treatment in older patients with epilepsy (≥60 years old).Methods The clinical data of 22 older patients with epilepsy who underwent surgical treatment from January 2013 to December 2021 in our epilepsy center were retrospectively analyzed,postoperative efficacy was assessed using Engel class,and surgery-related complications were followed up.Results 59.1% (13/22) of the22 older patients with epilepsy in this group had generalized tonic-clonic seizures,36.4% (8/22) of patients had a history of seizureclusters or status epilepticus.These 22 patients accounted for 1.6% (22/1392) of epilepsy surgeries in the same period,and surgery-related complications included:subcutaneous/subdural fluid in 4 cases,transient dysfunction in 2 cases,cerebral edema in 1 case and cerebral hemorrhage in 1 case.Histopathology included:brain tumor in 10 cases,gliosis in 4 cases,cerebrovascular disease in 2 cases,hippocampal sclerosis in 2 cases,focal cortical dysplasia in 2 cases,cerebral cysticercosis in 1 case,and unknown in 1 case.Three patients were lost to follow-up after surgery,three patients died due to tumor recurrence,and the remaining 16 patients were followed up for a mean of 35.1±19.9 months (12-84 months),with an outcome of 14 cases of Engel class I and 2 cases of Engel class II,and no permanent surgery-related complications occurred.Conclusion Older patients with epilepsy have ahigh risk from seizures and a large surgical treatment gap,and the postoperative outcome and safety of older patients with epilepsy screened for surgery through a comprehensive preoperative evaluation is good.

Key words: Older patients with epilepsy, Surgical outcome, Complications, Safety

摘要： 目的 探讨老年癫痫患者(≥60岁)的发作特征及外科治疗的疗效和安全性。方法 回顾性分析我中心2013年1月至2021年12月进行手术治疗的22例老年癫痫患者的临床资料,采用Engel分级标准评估术后疗效并随访手术相关并发症。结果 本组22例老年癫痫患者中59.1%(13/22)的患者有全面强直-阵挛发作,36.4%(8/22)的患者有丛集发作或癫痫持续状态史。22例患者占同期癫痫手术量的1.6%(22/1392),手术相关并发症包括:皮下/硬膜下积液4例、短暂功能障碍2例、脑水肿1例及脑出血1例。术后病理包括:脑肿瘤10例、胶质增生4例、脑血管病2例、海马硬化2例、局灶皮质发育不良2例、脑囊虫病1例及未知1例。术后3例患者失随访,3例患者因肿瘤复发死亡,其余16例患者平均随访35.1±19.9个月(12~84个月),疗效分布为Engel Ⅰ级14例、Engel Ⅱ级2例,无永久手术相关并发症发生。结论 老年癫痫患者发作时风险较高而外科治疗缺口大,通过综合的术前评估筛选合适的老年癫痫患者进行手术治疗,其术后疗效和安全性均较好。

关键词: 老年癫痫, 手术疗效, 并发症, 安全性