Seizure-Free Outcome of Repeated Epilepsy Surgery for Persistent or Recurrent Seizures
Abstract number :
3.333
Submission category :
9. Surgery / 9C. All Ages
Year :
2021
Submission ID :
1825913
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
Christian Vollmar, MD PhD - University of Munich; Philipp Karschnia, MD - University of Munich; Ingo Borggräfe, MD - University of Munich; Soheyl Noachtar, MD - University of Munich; Jörg-Christian Tonn, MD - University of Munich; Mathias Kunz, MD - University of Munich
Rationale: Reoperation may be an option for selected patients with unsatisfactory seizure control after the first epilepsy surgery, yet reports in the literature are limited. We describe seizure-free outcome of repeated epilepsy surgery in our tertiary referral center.
Methods: Thirty-five patients with focal refractory epilepsy, who underwent repeated epilepsy surgeries, and had a follow-up time after reoperation of at least six months, were included in the study. A systematic reevaluation including neuroimaging and non-invasive (n=32) and invasive (n=23) video-EEG-monitoring had been performed in all patients. Multimodal three-dimensional resection maps were created for individual patients to allow personalized reoperation.
Results: Median time from first operation to reoperation was 78 months (range 5-324 months). Median age at reoperation was 35 years (range 1 to 74 years) and median follow-up after reoperation was 26 months. Repeat MRI after the first epilepsy surgery showed an epileptogenic lesion in 25 patients (71%). The reoperation was temporal in 17 (49%) patients, extra-temporal in eight (23%) and multilobar in ten (28%). The site of reoperation was left hemispheric in 21 (62%) patients, close to eloquent cortex in 16 (46%), and distant from the initial resection in nine (26%). Regarding postoperative seizure outcome, 27 patients (77%) became seizure-free (Engel class I), while eight (23%) continued having seizures. None of the demographic or clinical factors were associated with seizure-free outcome.
Conclusions: Reoperation for refractory focal epilepsy can be an effective and safe option in patients with persistent or recurrent seizures after initial epilepsy surgery. A systematic and extensive presurgical reevaluation is essential for favorable outcome.
Funding: Please list any funding that was received in support of this abstract.: none.
Surgery