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Rates and predictors of success and failure in repeat epilepsy surgery: A meta-analysis and systematic review.

Publication ,  Journal Article
Krucoff, MO; Chan, AY; Harward, SC; Rahimpour, S; Rolston, JD; Muh, C; Englot, DJ
Published in: Epilepsia
December 2017

OBJECTIVE: Medically refractory epilepsy is a debilitating disorder that is particularly challenging to treat in patients who have already failed a surgical resection. Evidence regarding outcomes of further epilepsy surgery is limited to small case series and reviews. Therefore, our group performed the first quantitative meta-analysis of the literature from the past 30 years to assess for rates and predictors of successful reoperations. METHODS: A PubMed search was conducted for studies reporting outcomes of repeat epilepsy surgery. Studies were excluded if they reported fewer than five eligible patients or had average follow-ups < 1 year, and patients were excluded from analysis if they received a nonresective intervention. Outcomes were stratified by each variable of interest, and quantitative meta-analysis was performed to generate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Seven hundred eighty-two patients who received repeat resective epilepsy surgery from 36 studies were included. Engel I outcome was observed in 47% (n = 369) of patients. Significant predictors of seizure freedom included congruent over noncongruent electrophysiology data (OR = 3.6, 95% CI = 1.6-8.2), lesional over nonlesional epilepsy (OR = 3.2, 95% CI = 1.9-5.3), and surgical limitations over disease-related factors associated with failure of the first surgery (OR = 2.6, 95% CI = 1.3-5.3). Among patients with at least one of these predictors, seizure freedom was achieved in 58%. Conversely, the use of invasive monitoring was associated with worse outcome (OR = 0.4, 95% CI = 0.2-0.9). Temporal lobe over extratemporal/multilobe resection (OR = 1.5, 95% CI = 0.8-3.0) and abnormal over normal preoperative magnetic resonance imaging (OR = 1.9, 95% CI = 0.6-5.4) showed nonsignificant trends toward seizure freedom. SIGNIFICANCE: This analysis supports considering further resection in patients with intractable epilepsy who continue to have debilitating seizures after an initial surgery, especially in the context of factors predictive of a favorable outcome.

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Published In

Epilepsia

DOI

EISSN

1528-1167

Publication Date

December 2017

Volume

58

Issue

12

Start / End Page

2133 / 2142

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Reoperation
  • Neurology & Neurosurgery
  • Humans
  • Electroencephalography
  • Drug Resistant Epilepsy
  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences
 

Citation

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ICMJE
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Krucoff, M. O., Chan, A. Y., Harward, S. C., Rahimpour, S., Rolston, J. D., Muh, C., & Englot, D. J. (2017). Rates and predictors of success and failure in repeat epilepsy surgery: A meta-analysis and systematic review. Epilepsia, 58(12), 2133–2142. https://doi.org/10.1111/epi.13920
Krucoff, Max O., Alvin Y. Chan, Stephen C. Harward, Shervin Rahimpour, John D. Rolston, Carrie Muh, and Dario J. Englot. “Rates and predictors of success and failure in repeat epilepsy surgery: A meta-analysis and systematic review.Epilepsia 58, no. 12 (December 2017): 2133–42. https://doi.org/10.1111/epi.13920.
Krucoff MO, Chan AY, Harward SC, Rahimpour S, Rolston JD, Muh C, et al. Rates and predictors of success and failure in repeat epilepsy surgery: A meta-analysis and systematic review. Epilepsia. 2017 Dec;58(12):2133–42.
Krucoff, Max O., et al. “Rates and predictors of success and failure in repeat epilepsy surgery: A meta-analysis and systematic review.Epilepsia, vol. 58, no. 12, Dec. 2017, pp. 2133–42. Pubmed, doi:10.1111/epi.13920.
Krucoff MO, Chan AY, Harward SC, Rahimpour S, Rolston JD, Muh C, Englot DJ. Rates and predictors of success and failure in repeat epilepsy surgery: A meta-analysis and systematic review. Epilepsia. 2017 Dec;58(12):2133–2142.
Journal cover image

Published In

Epilepsia

DOI

EISSN

1528-1167

Publication Date

December 2017

Volume

58

Issue

12

Start / End Page

2133 / 2142

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Reoperation
  • Neurology & Neurosurgery
  • Humans
  • Electroencephalography
  • Drug Resistant Epilepsy
  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences