Efficacy of Surgical Treatment of De Novo, Adult-Onset, Cryptogenic, Refractory Focal Status Epilepticus

Costello, Daniel J.; Simon, Mirela V.; Eskandar, Emad N.; Frosch, Matthew P.; Henninger, Heidi; Chiappa, Keith H.; Cole, Andrew J.

doi:10.1001/archneur.63.6.895

Cited by 34 publications

(36 citation statements)

References 14 publications

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“…A retrospective study reported similar SE resolution in three patients who underwent either a cortical resection and multiple subpial transactions, completion of a callosotomy, or an anterior 2/3 callosotomy, followed by focal resection for recurrent SE [45]. In other case reports, cessation of SE was accomplished through single or consecutive treatments with these procedures [46][47][48][49][50].…”

Section: Surgerymentioning

confidence: 91%

Recent developments in the diagnosis and treatment of status epilepticus

Selvitelli

Drislane

2007

Curr Neurol Neurosci Rep

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Despite increased understanding of its potential complications, status epilepticus (SE) frequently remains difficult to diagnose and treat. Advances in continuous electroencephalogram (EEG) monitoring facilitate more rapid identification of SE, even without visible clinical signs of seizures. EEG monitoring assists in modifying SE treatment and in making a prognosis. Despite the improved recognition of SE, some patients continue to seize after treatment with intravenous benzodiazepines and other medications. There are new uses for valproic acid, levetiracetam, and topiramate, and they have evidence of efficacy in treating different forms of SE. If medical treatments do not terminate SE, other interventions, such as surgery and stimulation procedures, may promote seizure cessation. This article reviews recent studies evaluating the use of continuous EEG monitoring in the setting of SE, new uses of anticonvulsants, and nonpharmacologic interventions for SE.

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Section: Surgerymentioning

confidence: 91%

Recent developments in the diagnosis and treatment of status epilepticus

Selvitelli

Drislane

2007

Curr Neurol Neurosci Rep

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“…It is possible that the majority or even all patients with epilepsia partialis continua on invasive EEG monitoring would show similar PLEDs over the focal motor area of origin, thus ending any persistent debate as to their cortical origin. Several authors have discussed factors that determine the timing of surgical intervention for status epilepticus, and although probably not yet a mainstream consideration in the treatment of refractory status epilepticus, there certainly is a growing awareness and literature for consideration of this ''new,'' highly effective treatment option [9,16,[19][20][21][22][23][24][25][26][27]. Table 1 summarizes the previously published 30 cases of different neurosurgical procedures performed, including vagus nerve stimulation (in two patients) for various forms of status epilepticus and different etiologies.…”

Section: Discussionmentioning

confidence: 99%

The role of neurosurgery in status epilepticus

Bristol

Schrader

et al. 2007

Neurocrit Care

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This case illustrates a potentially life-saving technique for the treatment of refractory status epilepticus. Multiple subpial transections and other neurosurgical intervention should be considered for patients with status epilepticus. When localization with surface electrodes is poor, especially in eloquent cortex, subdural grid recording can be used to direct focal resection and/or multiple subpial transections to minimize neurological deficits. A review and summary of previously published neurosurgery cases for status epilepticus is discussed.

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“…Multiple case series subsequently documented the role of surgical intervention for RSE. 1,3,4,[9][10][11][12]16,17,19,20,22,24,27 Interventions included focal cortical resection, hemispherectomy, MST, vagus nerve stimulation, and callosotomy. Ng et al 20 described 5 patients with RSE successfully treated with neurosurgical intervention: 3 who underwent focal cortical resection and 1 each who underwent hemispherectomy and transcallosal resection of a hypothalamic hamartoma.…”

Section: Van Nessmentioning

confidence: 99%

“…Studies on the surgical treatment of RSE are therefore limited to single case reports or small series involving cortical resection, callosal sectioning, multiple subpial transections (MSTs), hemispherectomy, and vagus nerve stimulation. 1,3,4,[9][10][11][12]16,17,19,20,24 There is no consensus on how or when to surgically manage this medical emergency. Object.…”

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confidence: 99%

Surgical treatment of refractory status epilepticus in children

Bhatia

Ahmad²,

Miller

et al. 2013

PED

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Object Refractory status epilepticus (RSE) is a life-threatening neurological emergency associated with high morbidity and mortality. Affected patients often require prolonged intensive care and can suffer multiple complications. Surgical intervention to control RSE is rarely used but can obviate the risks of prolonged seizures and intensive care treatment. Authors of the present study analyzed their experience with the surgical management of patients suffering from RSE. Methods The Epilepsy Surgery Database at Miami Children's Hospital was reviewed for patients who had undergone surgery for RSE. Clinical presentation, electrophysiological profile, radiological data, surgical details, and postoperative course were evaluated. Results Between 1990 and 2012, 15 patients underwent surgery for uncontrolled seizures despite high-dose medical suppressive therapy. The mean preoperative duration of status epilepticus was 8 weeks. Ictal SPECT and FDG-PET imaging in conjunction with intraoperative electrophysiological studies helped to outline the extent of resection. Surgical intervention controlled seizures in all patients and facilitated the transition out of intensive care. Adverse events related to a prolonged intensive care unit stay included sepsis and respiratory complications. Four patients had worsened neurological function, developing hemiparesis and dysphasia. There was no operative mortality. Conclusions Surgical intervention can successfully control refractory partial status epilepticus, prevent associated morbidity, and decrease intensive care unit stay. Ictal SPECT and PET are valuable in guiding resection.

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Efficacy of Surgical Treatment of De Novo, Adult-Onset, Cryptogenic, Refractory Focal Status Epilepticus

Abstract: Background: There have been few published reports of successful surgical treatment of focal status epilepticus. Surgical intervention is considered a last resort after medical strategies have been exhausted.

Cited by 34 publications

References 14 publications

Recent developments in the diagnosis and treatment of status epilepticus

Recent developments in the diagnosis and treatment of status epilepticus

The role of neurosurgery in status epilepticus

Surgical treatment of refractory status epilepticus in children

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