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Meta-Analysis
. 2017 Dec;58(12):2133-2142.
doi: 10.1111/epi.13920. Epub 2017 Oct 10.

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

Max O Krucoff  1 , Alvin Y Chan  2 , Stephen C Harward  1 , Shervin Rahimpour  1 , John D Rolston  3 , Carrie Muh  1 , Dario J Englot  4
Affiliations
Meta-Analysis

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

Max O Krucoff et al. Epilepsia. 2017 Dec.

Abstract

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.

Keywords: Redo; Reoperation; Reresection; Secondary; Seizure.

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Conflict of interest statement

Conflicts of Interest

The authors declare we have no conflicts of interest

Disclosure

None of the authors has any conflict of interest to disclose

Figures

Figure 1
Figure 1
Literature search guided by PRISMA.
Figure 2
Figure 2
Reported seizure free rates of repeat epilepsy surgeries over time. Linear regression revealed no significant trend (r = 0.14, p = 0.33).
Figure 3
Figure 3
Forest plots showing meta-analysis results.
See this image and copyright information in PMC

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