Repeat surgery is worth considering in patients with intractable epilepsy if they continue to have debilitating episodes after the first procedure, according to a meta-analysis and systematic review that looked at 782 patients from 36 studies. But the success of repeat resection is dependent on several positive and negative predictive factors.
- Krucoff et al conducted the first quantitative meta-analysis of theresearch literature from the last 30 years to determine the rate of successful repeat surgeries and to find predictors.
- Congruent electrophysiology data was a better predictor of seizure freedom when compared to noncongruent data, with an odds ratio (OR) of 3.6.
- Freedom from seizures after repeat surgery was better predicted for lesional than nonlesional epilepsy (OR, 3.2).
- Another predictor of seizure freedom was surgical limitations, when compared to disease-related factors that had been associated with failure of the first surgery. (OR, 2.6).
- 58% of patients were seizure free after repeat resection if they had at least one of these predictive factors.
Krucoff MO, Chan AY, Harward SC, et al. Rates and predictors of success and failure in repeat epilepsy surgery: a meta-analysis and systematic review. [Published online ahead of print October 10, 2017] Epilepsia. doi: 10.1111/epi.13920.