Introduction from Dr Markus Reuber, editor-in-chief of Seizure
Reducing birth rates and increasing life expectancy mean that many developed and developing societies are aging. This and the fact that many age-related conditions are associated with epilepsy mean that the demographics of epilepsy are changing. These societal changes have gone hand in hand with the increasing recognition that ageism - or in this context the restriction of services, rights or opportunities on the grounds of older age alone - is unacceptable. However, the notion that clear age cut-offs are inappropriate (an open to legal challenge in many countries) creates new problems, especially in medicine, where age-related features can have a clear effect on treatment outcomes and must therefore be taken into account when therapeutic choices are made. This is highly relevant to decisions about epilepsy surgery.
Previous publications demonstrate how age-related cognitive decline may put older patients undergoing epilepsy surgery at particular risk (1), and several papers (including work published in Seizure) (2) suggest that seizure outcomes may also be worse in older adults.
My editor's choice from this issue of seizure by Fatima Bialek, Kristina Malmgren, Bertil Rydenhag and Roland Flink will help neurologists and their older patients make better-informed decisions about epilepsy surgery, when decision-making processes are not based on a numeric age cut-off but on the consideration of all factors which are either medically relevant, particularly important to the patient or both (3). In short, Bialek et al. find no significant differences in seizure or social outcomes between their patients aged 19-49 or their patients aged 50+. Whilst it is regrettable that the in other ways excellent Swedish patient register on which this study is based does not contain any details about neuropsychological outcomes, it is reassuring to note that, despite their greater age, as many people in the older age group changed status from "not working or studying" to "working or studying" as in the younger group of patients and that the risk of serious complications was no greater in older patients.
As such, this publication is one more nail in the coffin of epilepsy surgery programs, planners, managers or politicians who think that it is easily defensible only to offer surgical treatments to younger adults.
 Elger CE, Helmstaedter C, Kurthen M. Chronic epilepsy and cognition. The Lancet Neurology 2004; 11: 663-672.
 Srikijvilaikul T, Lerdlum S, Tepmongkol S, Shuangshotim S, Locharernkul C. Outcome of temporal lobectomy for hippocampal sclerosis in older patients. Seizure 2011; 20: 276–279.
 Bialek F, Malmgren K, Rydenhag B, Flink R. Outcomes after resective epilepsy surgery in patients over 50 years of age in Sweden 1990-2009 - a prospective longitudinal study. Seizure 2014; 23: 641-645.