Cruz et al. of the Cleveland Clinic retrospectively evaluated pathological changes in surgically resected samples from patients with refractory epilepsy and published the results in a recent issue of Annals of Diagnostic Pathology. The study included 102 patients (56 women) with refractory epilepsy who had at least 2 surgical experiences (more than 60 days between surgeries). In the first surgically resected tissue, the most common pathological changes were localized cortical dysplasia (45%), tumors (19%), hippocampal sclerosis (16%), and nonspecific changes (13%). In the second surgical excision of tissue, the most common pathological changes were old infarcts (51 cases) and local cortical dysplasia (29 cases). Of the 89 patients who had initial significant pathologic changes, 74 also had significant pathologic changes at the second surgery, 49 of which had the same pathologic changes. It was found that most patients with recurrent epilepsy who underwent at least 2 surgeries (84%) had pathologic changes leading to seizures that could be found in the second surgery, and most patients (55%) had similar pathologic changes in the initial and second surgery; in some patients, traumatic damage from the surgery may have been the cause of persistent seizures after the initial surgery.