ArticleEpilepsia2020
Long-term outcomes of reoperations in epilepsy surgery.
Article in Epilepsia, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 60 citations in OpenAlex.
- Outcome of Surgery for Hypothalamic Hamartoma-Related Epilepsy: A Systematic Review and Individual Participant Data Meta-Analysis.Neurology · 2024Pooled it
- Epilepsy Surgery in a Resource-Limited Latin-American Center: Presurgical Evaluation Findings and Early ILAE Outcomes in a Mixed Adult-Pediatric Cohort.Brain sciences · 2026Article
- Review
- Epileptogenesis and Epilepsy Treatment: Advances in Mechanistic Understanding, Therapeutic Approaches, and Future Perspectives.International journal of molecular sciences · 2026Review
- Seminars in epileptology: Presurgical epilepsy evaluation.Epileptic disorders : international epilepsy journal with videotape · 2025Review
- Long-term outcomes of epilepsy surgery: A 25-year experience from a tertiary referral center.Epileptic disorders : international epilepsy journal with videotape · 2025Article
- Epilepsy Surgery in Kazakhstan: Outcomes and the Role of Advanced Imaging.Journal of clinical medicine · 2025Article
- Peri-operative anti-inflammatory drug use and seizure recurrence after resective epilepsy surgery: Target trials emulation.iScience · 2025Article
- Resective epilepsy surgery in pediatric patients with normal MRI: outcomes, challenges, and cost-effectiveness in low-resource settings.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2025Article
- Somatic DNA Variants in Epilepsy Surgery Brain Samples from Patients with Lesional Epilepsy.International journal of molecular sciences · 2025Article
- Combined MRI morphometry and source imaging guide placement of stereo-EEG electrodes in focal epilepsy with subtle or absent lesions.Frontiers in neurology · 2025Article
- SimultaneousNeuroradiology · 2025Article
- Surgical outcomes of drug-refractory infantile epileptic spasms syndrome and related prognostic factors: a retrospective study.Acta epileptologica · 2024Article
- Outcomes of stereoelectroencephalography following failed epilepsy surgery in children.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2024Article
- Predictors of SOZ localization, subsequent surgical intervention, and seizure outcomes in iEEG.Annals of clinical and translational neurology · 2024Article
- Consensus on pediatric epilepsy surgery for young children: an investigation by the China Association Against Epilepsy task force on epilepsy surgery.Acta epileptologica · 2023Article
- Can machine learning solve this one? Clinical pitfalls in surgical outcome prediction.Epilepsia · 2023Article
- Landscape and future directions of machine learning applications in closed-loop brain stimulation.NPJ digital medicine · 2023Review
- Beyond seizure freedom: Dissecting long-term seizure control after surgical resection for drug-resistant epilepsy.Epilepsia · 2023Article
- Predictors of Seizure Outcome after Repeat Pediatric Epilepsy Surgery: Reasons for Failure, Sex, Electrophysiology, and Temporal Lobe Surgery.Neurologia medico-chirurgica · 2022Article
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo analyze longitudinal seizure outcomes following epilepsy surgery, including reoperations, in patients with intractable focal epilepsy.
methodsClinicoradiological characteristics of patients who underwent epilepsy surgery from 1995 to 2016 with follow-up of ≥1 year were reviewed. In patients undergoing reoperations, the latest resection was considered the index surgery. The primary outcome was complete seizure freedom (Engel I) at last follow-up. Potentially significant outcome variables were first identified using univariate analyses and then fit in multivariate Cox proportional hazards models.
resultsOf 898 patients fulfilling study criteria, 110 had reoperations; 92 had one resection prior to the index surgery and 18 patients had two or more prior resective surgeries. Two years after the index surgery, 69% of patients with no prior surgeries had an Engel score of I, as opposed to only 42% of those with one prior surgery, and 33% of those with two or more prior resections (P < .001). Among surgical outcome predictors, the number of prior epilepsy surgeries, female sex, lesional initial magnetic resonance imaging, no prior history of generalization, and pathology correlated with better seizure outcomes on univariate analysis. However, only sex (P = .011), history of generalization (P = .016), and number of prior surgeries (P = .002) remained statistically significant in the multivariate model. SIGNIFICANCE: Although long-term seizure control is possible in patients with failed prior epilepsy surgery, the chances of success diminish with every subsequent resection. Outcome is additionally determined by inherent biological markers (sex and secondary generalization tendency), rather than traditional outcome predictors, supporting a hypothesis of "surgical refractoriness."
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