Long-term seizure control is achievable in patients with failed prior epilepsy surgery, but the likelihood of success decreases with each reoperative attempt, regardless of other clinical factors. So finds the first single-center study of longitudinal outcomes and outcome predictors following epilepsy reoperations in a large cohort of patients with medically refractory focal epilepsy.
The study, published by Cleveland Clinic Epilepsy Center staff in Epilepsia, proposes a novel concept of “surgical refractoriness” as a possible contributor to the diminishing returns from repeated epilepsy surgeries.
“Our findings, particularly the notion of surgical refractoriness of the epileptogenic zone, underscore the need for prudent selection of candidates for reoperative epilepsy surgery,” says the study’s corresponding author, Lara Jehi, MD, Research Director in Cleveland Clinic’s Epilepsy Center. “As our tools for seizure localization improve, there is an understandable urge to consider further surgery after a previous surgical failure, to address any residual epileptogenic tissue. However, our results build on other recent data suggesting that inherent and potentially genetic patient characteristics may raise the risk of operative failure regardless of the quality of localization and resection.”