Seizure-free outcome and safety of repeated epilepsy surgery for persistent or recurrent seizures

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  • 1 Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University of Munich;
  • | 2 Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine, University Hospital of the Ludwig-Maximilians-University of Munich; and
  • | 3 Department of Neurology, Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany
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OBJECTIVE

Reoperation may be an option for select patients with unsatisfactory seizure control after their first epilepsy surgery. The aim of this study was to describe the seizure-free outcome and safety of repeated epilepsy surgery in our tertiary referral center.

METHODS

Thirty-eight patients with focal refractory epilepsy, who underwent repeated epilepsy surgeries and had a minimum follow-up time of 12 months after reoperation, were included. Systematic reevaluation, including comprehensive neuroimaging and noninvasive (n = 38) and invasive (n = 25, 66%) video-electroencephalography monitoring, was performed. Multimodal 3D resection maps were created for individual patients to allow personalized reoperation.

RESULTS

The median time between the first operation and reoperation was 74 months (range 5–324 months). The median age at reoperation was 34 years (range 1–74 years), and the median follow-up was 38 months (range 13–142 months). Repeat MRI after the first epilepsy surgery showed an epileptogenic lesion in 24 patients (63%). The reoperation was temporal in 18 patients (47%), extratemporal in 9 (24%), and multilobar in 11 (29%). The reoperation was left hemispheric in 24 patients (63%), close to eloquent cortex in 19 (50%), and distant from the initial resection in 8 (21%). Following reoperation, 27 patients (71%) became seizure free (Engel class I), while 11 (29%) continued to have seizures. There were trends toward better outcome in temporal lobe epilepsy and for unilobar resections adjacent to the initial surgery, but there was no difference between MRI lesional and nonlesional patients. In all subgroups, Engel class I outcome was at least 50%. Perioperative complications occurred in 4 patients (11%), with no fatalities.

CONCLUSIONS

Reoperation for refractory focal epilepsy is an effective and safe option in patients with persistent or recurrent seizures after initial epilepsy surgery. A thorough presurgical reevaluation is essential for favorable outcome.

ABBREVIATIONS

DTI = diffusion tensor imaging; EEG = electroencephalography; EZ = epileptogenic zone; fMRI = functional MRI; ILAE = International League Against Epilepsy; sEEG = stereo-EEG.

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  • 1

    Ryvlin P, Cross JH, Rheims S. Epilepsy surgery in children and adults. Lancet Neurol. 2014;13(11):11141126.

  • 2

    Wiebe S, Blume WT, Girvin JP, Eliasziw M. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001;345(5):311318.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    de Tisi J, Bell GS, Peacock JL, et al. The long-term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: a cohort study. Lancet. 2011;378(9800):13881395.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Spencer S, Huh L. Outcomes of epilepsy surgery in adults and children. Lancet Neurol. 2008;7(6):525537.

  • 5

    Lamberink HJ, Otte WM, Blümcke I, Braun KPJ. Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study. Lancet Neurol. 2020;19(9):748757.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Helmstaedter C, Elger CE, Vogt VL. Cognitive outcomes more than 5 years after temporal lobe epilepsy surgery: remarkable functional recovery when seizures are controlled. Seizure. 2018;62:116123.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Perry MS, Duchowny M. Surgical versus medical treatment for refractory epilepsy: outcomes beyond seizure control. Epilepsia. 2013;54(12):20602070.

  • 8

    Hamiwka L, Macrodimitris S, Tellez-Zenteno JF, et al. Social outcomes after temporal or extratemporal epilepsy surgery: a systematic review. Epilepsia. 2011;52(5):870879.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Chassoux F, Rodrigo S, Semah F, et al. FDG-PET improves surgical outcome in negative MRI Taylor-type focal cortical dysplasias. Neurology. 2010;75(24):21682175.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Thorsteinsdottir J, Vollmar C, Tonn JC, Kreth FW, Noachtar S, Peraud A. Outcome after individualized stereoelectroencephalography (sEEG) implantation and navigated resection in patients with lesional and non-lesional focal epilepsy. J Neurol. 2019;266(4):910920.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):10691077.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    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. Epilepsia. 2017;58(12):21332142.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Yardi R, Morita-Sherman ME, Fitzgerald Z, et al. Long-term outcomes of reoperations in epilepsy surgery. Epilepsia. 2020;61(3):465478.

  • 14

    Engel J, Van Ness P, Rasmussen T, et al. Outcome with respect to epileptic seizures. In: Engel J, ed.Surgical Treatment of the Epilepsies. Raven Press; 1993:609621.

    • Search Google Scholar
    • Export Citation
  • 15

    Wieser HG, Blume WT, Fish D, et al. ILAE Commission Report. Proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia. 2001;42(2):282286.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Vollmar C, Peraud A, Noachtar S. Multimodal imaging in extratemporal epilepsy surgery. Cureus. 2018;10(3):e2338.

  • 17

    Surges R, Elger CE. Reoperation after failed resective epilepsy surgery. Seizure. 2013;22(7):493501.

  • 18

    Schmeiser B, Zentner J, Steinhoff BJ, et al. The role of presurgical EEG parameters and of reoperation for seizure outcome in temporal lobe epilepsy. Seizure. 2017;51:174179.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Shawarba J, Kaspar B, Rampp S, et al. Advantages of magnetoencephalography, neuronavigation and intraoperative MRI in epilepsy surgery re-operations. Neurol Res. 2021;43(6):434439.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Reed CM, Dewar S, Fried I, Engel J Jr, Eliashiv D. Failed epilepsy surgery deserves a second chance. Clin Neurol Neurosurg. 2017;163:110115.

    • Search Google Scholar
    • Export Citation
  • 21

    Juhász C, Chugani DC, Padhye UN, et al. Evaluation with α-[11C]methyl-l-tryptophan positron emission tomography for reoperation after failed epilepsy surgery. Epilepsia. 2004;45(2):124130.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    El Tahry R, Wang ZI, Thandar A, et al. Magnetoencephalography and ictal SPECT in patients with failed epilepsy surgery. Clin Neurophysiol. 2018;129(8):16511657.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Mo JJ, Hu WH, Zhang C, et al. Value of stereo-electroencephalogram in reoperation of patients with pharmacoresistant epilepsy: a single center, retrospective study. Br J Neurosurg. 2018;32(6):663670.

    • Crossref
    • Search Google Scholar
    • Export Citation

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