Surgical treatment for temporal lobe epilepsy in patients over age 50 years

We retrospectively analyzed 4 patients over age 50 (52-57) years with intractable medial temporal lobe epilepsy (MTLE) who underwent the anterior temporal lobectomy with hippocampectomy. Case 1 had MTLE with old brain abscess in the left lateral temporal lobe and Cases 2-4 had MTLE with histologically verified hippocampal sclerosis. In Cases 2-4, although the onset of seizures occurred 26 to 37 years prior to the time of surgery, there was no mental problem (IQ = 87-100). In Cases 1, chronic invasive electrocorticography recording using subdural electrodes was obtained, while in Case 2-4, the epileptogenic region was defined by noninvasive preoperative evaluation. Postoperatively, all patients obtained a meaningful improvement, becoming either free from seizures or only experiencing a rare seizure, and returned to work or usual activities without surgical complications. Surgery for MTLE appears to be effective for older individuals and carries a small risk of postoperative complications.