Seizure Outcome After Ipsitemporal Reoperation in Pharmacoresistant Temporal Lobe Epilepsy Patients With Hippocampal Sclerosis and Nonspecific Pathology

Abstract

BACKGROUND Treatment of patients with pharmacoresistant temporal lobe epilepsy with hippocampal sclerosis and nonspecific pathology who failed initial resection is challenging, although selected patients may benefit from repeated surgery. OBJECTIVE To determine seizure outcome, postoperative morbidity, and possible predictors of seizure freedom after repeated ipsitemporal resection. METHODS We reviewed the results of comprehensive epilepsy evaluations performed before the initial and repeated resections in 10 patients with hippocampal sclerosis and 13 with nonspecific pathology. We assessed the Engel classification of seizure outcome 2 yr after repeated resection, evaluated postoperative morbidity, and examined the association of epilepsy and surgical characteristics with seizure freedom before and after reoperation. RESULTS After reoperation, in patients with hippocampal sclerosis, seizure freedom (Engel class I) was achieved in 2 (20%), 1 (10%) experienced surgical complications, and 1 (10%) experienced permanent neurological impairment. Following reoperation in patients with nonspecific pathology, seizure freedom was achieved in 1 (8%), 3 (23%) experienced surgical complications, and 4 (31%) experienced permanent neurological impairment. Epilepsy and surgical characteristics before and after reoperation were not associated with seizure freedom. CONCLUSION Patients with hippocampal sclerosis and nonspecific pathology who underwent a comprehensive initial work-up and failed original temporal lobe resection rarely become seizure-free after repeated ipsitemporal reoperation. Reoperations carry a high risk of surgical complications and neurological impairment. Predictors for seizure freedom could not be defined.