Abstracts

Treatment of patients who fail epilepsy surgery is problematic. There are few other treatment options available for this group of patients. Indeed many of these patients may be candidates for further resective surgery. The purpose of this study was to study the outcome following re-operation and identify factors predictive of good outcome in these patients. We performed a retrospective consecutive chart review of patients that underwent re-opertion for medically intractable epilepsy at our institution from 1990-2001. Seventy patients underwent re-operative epilepsy surgery with 57 having a minimum of 1 year follow-up. Factors associated with outcome were studied. Histopathology of re-operated cases included tumors (31.6%), cortical dysplasia (CD) (21.1%), hippocampal sclerosis (HS) (17.5%), dual pathology (10.5%) and non-specific pathology (19.3%). There were no significant differences in outcome in patients undergoing temporal versus extra-temporal lobe re-operations. Febrile seizure, family history of seizures, or the seizure-free period after the first surgery were not predictive of final seizure outcome. Fifty percent of patients had favorable outcomes (Engel I and II) following re-operations. Patients with tumors and CD on initial pathology had better outcomes although this did not reach statistical significance. Re-operation in selected patients failing epilepsy resective surgery should be considered as 50% of patients with limited other treatment options may benefit. Patients with neoplastic disease or dysplastic pathology tended to have better outcomes.