Yardi R, Morita-Sherman ME, Fitzgerald Z, et al. - Among 898 patients with intractable focal epilepsy, researchers examined longitudinal seizure outcomes following epilepsy surgery, including reoperations. Clinicoradiological features of patients who had epilepsy surgery from 1995 to 2016 with a follow-up of ≥ 1 year have been reviewed. The latest resection was considered the index surgery in patients undergoing reoperations. Among surgical outcome predictors, the number of prior epilepsy surgeries, female gender, lesional initial MRI, no prior history of generalization, and pathology associated with better seizure outcomes on univariate analysis. However, the multivariate model remained statistically significant only for gender, generalization history, and the number of prior surgeries. Although long-term seizure control is possible in patients who have failed prior epilepsy surgery, with each subsequent resection, the chances of success decline. In addition, the outcome is determined by inherent biological markers (gender and secondary generalization tendency), rather than by traditional outcome predictors, which endorse a "surgical refractoriness" hypothesis.