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This Article Full Text Full Text (PDF) CME: Take the course for this article: Volume 63, Number 12, December 28, 2004 Data Supplement Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Related articles in Neurology Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Siegel, A. M. Articles by Sharbrough, F. W. Search for Related Content PubMed PubMed Citation Articles by Siegel, A. M. Articles by Sharbrough, F. W. Related Collections All Epilepsy/Seizures Epilepsy surgery

Resective reoperation for failed epilepsy surgery

Seizure outcome in 64 patients

From the Division of Epilepsy (Drs. Siegel, Cascino, So, and Sharbrough) and Section of Electroencephalography (Drs. Cascino, So, and Sharbrough), Departments of Neurology (Drs. Cascino, So, and Sharbrough), Neurologic Surgery (Drs. Meyer and Marsh), and Pathology (Dr. Scheithauer), and Section of Biostatistics (Dr. McClelland), Mayo Clinic, Rochester, MN; and Department of Neurology (Dr. Siegel), University of Zurich, Switzerland.

Address correspondence and reprint requests to Dr. G.D. Cascino, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; e-mail: gcascino{at}mayo.edu

Objective: To determine the surgical outcome and factors of predictive value in patients undergoing reoperation for intractable partial epilepsy.

Methods: The authors retrospectively studied the operative outcome in 64 consecutive patients who underwent reoperation for intractable partial epilepsy. Demographic data, results of comprehensive preoperative evaluations, and the seizure and neurologic outcome after reoperation were determined. All patients were followed a minimum of 1 year subsequent to their last operative procedure.

Results: Fifty-three patients had two surgeries, and 11 patients had three or more operations. The first surgery involved a lesionectomy (n = 33), "nonlesional" temporal lobe resection (n = 28), and a "nonlesional" extratemporal resection (n = 3). The mean duration between the first and second procedure was 5.5 years. Fifty-five patients underwent an intralobar reoperation, whereas nine had a resection of a different lobe. After reoperation, 25 patients (39%) were free of seizure, 6 patients (9%) had rare seizures, 12 patients (19%) had a worthwhile improvement, and 21 patients (33%) failed to respond to surgery. Predictors of seizure-free outcome were age at seizure onset >15 years (p = 0.01), duration of epilepsy 5 years at the time of initial surgery (p = 0.03), and focal interictal discharges in scalp EEG (p = 0.03). Using a logistic regression model, two significant predictors emerged: duration of epilepsy 5 years (odds ratio, 3.18; p = 0.04) and preoperative focal interictal discharge (odds ratio, 4.45; p = 0.02). Complications of reoperation included visual field deficits (n = 9), wound infection (n = 2), subdural hematoma (n = 1), and hemiparesis (n = 1).

Conclusion: Reoperation may be an appropriate alternative form of treatment for selected patients with intractable partial epilepsy who fail to respond to initial surgery.

Received January 31, 2003. Accepted in final form August 18, 2004.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the December 28 issue to find the title link for this article.

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Neurology 2004 63: 2202-2003. [Full Text]