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This chapter provides an overview of biological and psychosocial issues that may be associated with seizure recurrence after epilepsy surgery. It reviews seizure recurrence without introducing the variable constituted by antiepileptic drugs (AED) tapering or discontinuation. Unilateral mesial temporal lobe epilepsy due to hippocampal sclerosis (MTLE/HS) is the prototype of a surgically remediable epilepsy syndrome, in which the chances for medical control are reduced whereas the chances for surgical remediation are elevated. The chapter discusses what could be seen as de novo epilepsy after epilepsy surgery and is subdivided into two independent parts: postoperative seizures possibly related to surgically inflicted cortical damage, and postoperative seizures possibly associated with disinhibition of a potential epileptogenic zone (EZ). Stopping AEDs would be the closest construct for the cure of epilepsy. There is evidence that at least in some pathologies epilepsy may be a release phenomenon following initial resection for epilepsy.
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