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Epilepsia. 2017 Dec;58(12):2133-2142. doi: 10.1111/epi.13920. Epub 2017 Oct 10.

Rates and predictors of success and failure in repeat epilepsy surgery: A meta-analysis and systematic review.

Author information

1
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
2
Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
3
Department of Neurosurgery, University of Utah, Salt Lake City, Utah, U.S.A.
4
Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

Abstract

OBJECTIVE:

Medically refractory epilepsy is a debilitating disorder that is particularly challenging to treat in patients who have already failed a surgical resection. Evidence regarding outcomes of further epilepsy surgery is limited to small case series and reviews. Therefore, our group performed the first quantitative meta-analysis of the literature from the past 30 years to assess for rates and predictors of successful reoperations.

METHODS:

A PubMed search was conducted for studies reporting outcomes of repeat epilepsy surgery. Studies were excluded if they reported fewer than five eligible patients or had average follow-ups < 1 year, and patients were excluded from analysis if they received a nonresective intervention. Outcomes were stratified by each variable of interest, and quantitative meta-analysis was performed to generate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS:

Seven hundred eighty-two patients who received repeat resective epilepsy surgery from 36 studies were included. Engel I outcome was observed in 47% (n = 369) of patients. Significant predictors of seizure freedom included congruent over noncongruent electrophysiology data (OR = 3.6, 95% CI = 1.6-8.2), lesional over nonlesional epilepsy (OR = 3.2, 95% CI = 1.9-5.3), and surgical limitations over disease-related factors associated with failure of the first surgery (OR = 2.6, 95% CI = 1.3-5.3). Among patients with at least one of these predictors, seizure freedom was achieved in 58%. Conversely, the use of invasive monitoring was associated with worse outcome (OR = 0.4, 95% CI = 0.2-0.9). Temporal lobe over extratemporal/multilobe resection (OR = 1.5, 95% CI = 0.8-3.0) and abnormal over normal preoperative magnetic resonance imaging (OR = 1.9, 95% CI = 0.6-5.4) showed nonsignificant trends toward seizure freedom.

SIGNIFICANCE:

This analysis supports considering further resection in patients with intractable epilepsy who continue to have debilitating seizures after an initial surgery, especially in the context of factors predictive of a favorable outcome.

KEYWORDS:

Redo; Reoperation; Reresection; Secondary; Seizure

PMID:
28994113
PMCID:
PMC5716856
[Available on 2018-12-01]
DOI:
10.1111/epi.13920
[Indexed for MEDLINE]

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