Seizure outcomes and predictors in patients with repeat epilepsy surgery

Abstract (1) Background: One of the most important goals of surgical epilepsy treatment is seizure freedom. Patients who continue to experience seizures after epilepsy surgery could be considered for a repeat surgical treatment. This study aimed to analyze the seizure outcomes of re-peat surgical treatment of epilepsy and evaluate the prognostic factors. (2) Methods: This single-center cohort study retrospectively collected clinical data from patients undergoing repeat epilepsy surgery at the Aviation General Hospital from 2016 to 2022. Patients who met the inclusion criteria were followed up for at least one year, and seizure outcomes were based on the International League Against Epilepsy (ILAE) seizure outcome classification. (3) Results: A total of 43 patients were included in this study, with a mean follow-up of 43.95 months. Malformation of cortical development was the most common postoperative pathology finding, occurring in 19 (44.2%) patients, followed by tumors in seven (16.3%) patients. Following repeat epilepsy surgery, 23 (53.5%) patients achieved ILAE Class 1 or 2. Multifactorial analysis showed that lesional magnetic resonance imaging (MRI) was associated with favorable seizure outcomes, and bilateral or multifocal ictal discharge patterns predicted poor seizure outcomes. Repeat epilepsy surgeries resulted in 13 (30.2%) patients with permanent neurological deficits. (4) Conclusions: Following a detailed assessment, including imaging, electroencephalography (EEG), and invasive evaluation, repeat epilepsy surgery is a safe and effective option for patients who have failed resective epilepsy surgery. Meanwhile, possible neurological permanent deficits should be taken into account when considering repeat surgery.