Factors associated with seizure recurrence in patients undergoing repeat epilepsy surgery: a retrospective analysis

Epilepsy surgery is a crucial intervention for cases of drug-resistant epilepsy, aiming to achieve seizure freedom. Despite significant success rates, some patients continue to experience seizures post-surgery, leading to the need for repeat interventions.

This study employed a retrospective observational design, focusing on patients who underwent repeat epilepsy surgery at our hospital. All patients underwent standardized evaluations, including electroencephalography (EEG), magnetic resonance imaging (MRI), and, in select cases, positron emission tomography (PET) and invasive intracranial electrode monitoring.

In a retrospective analysis of 43 patients who underwent repeat epilepsy surgery, with an average follow-up of 43.95 months, 53.5% achieved favorable outcomes based on ILAE Class 1 or 2 criteria. Preoperative MRI indicating lesions was associated with a better prognosis, with an odds ratio (OR) of 0.049 (95% CI: 0.003 to 0.873, p = 0.040). Conversely, EEG showing multifocal epileptiform discharges predicted poorer outcomes, with an OR of 25.082 (95% CI: 1.726 to 364.533, p = 0.018). Surgical complications occurred in 30.2% of patients, with visual field defects, mild hemiparesis, and infections being the most common.

A thorough assessment involving imaging, EEG, and invasive evaluation indicates that repeat epilepsy surgery is a safe and selective option for patients who have not achieved seizure freedom after initial resective surgery.