Abstracts

Treatment of patients who fail epilepsy surgery is problematic. Selected patients may be candidates for further surgery, potentially leading to a significant decrease in seizures frequency and severity. The purpose of this manuscript is to present our long-term outcome series of highly investigated patients who failed resective epilepsy surgery and subsequently underwent re-operative resective procedures. Additionally, our intention is to identify possible factors associated with unsatisfactory seizure outcome, improving selection criteria for re-operation in failed epilepsy surgery., We performed a retrospective consecutive analysis of patients who underwent re-operative procedures due to medically intractable epilepsy at our institution from 1990 to 2001. Seventy patients underwent re-operative epilepsy surgery with 57 patients having a minimum follow-up of 2 years. We assessed the relationship between seizure outcome and categorical variables using Chi-square and Fisher[apos]s exact tests, and the relationship between outcome and continuous variables using Wilcoxon rank-sum test. For all analyses, statistical significance was set at a p value of 0.05., Of the 57 patients, there were 29 males and 28 females. Age of seizure onset ranged from 3 months to 39 years (mean 10.7[plusmn]10.3 years, median 7 years). The mean age at re-operation was 24.7[plusmn]12 years (range 4-50 years). Follow-up ranged from 24 to 228 months (mean: 128 months, mode: 132 months). Seizure outcome were classified according to Engel[apos]s classification and divided in two groups: Favorable outcome (Engel[apos]s classes I and II) and non-favorable outcome (Engel[apos]s classes III and IV). Fifty two percent of patients had favorable outcome. Patients with tumors as initial pathology had better outcome in comparison with malformations of cortical development (MCD) and mesial temporal sclerosis (MTS) (p[lt]0.05)., Re-operation in selected patients failing epilepsy resective surgery should be considered as approximately 50% of patients may have benefit. Patients with MCD and MTS are less likely to improve after re-operation.,