Resective surgery to treat refractory status epilepticus in children with focal epileptogenesis

Abstract

Prolonged high-dose suppressive therapy (HDST) is a mainstay in the management of refractory status epilepticus (RSE), albeit with high morbidity and mortality. The authors studied 10 patients who were carefully selected for epilepsy surgery after failing prolonged (>2 weeks) HDST. Status epilepticus was stopped acutely in all of them with no mortality and no substantial morbidity. At follow-up (median 7 months), 7 (70%) of 10 patients were seizure free, and 3 (30%) of 10 had significant improvement in their epilepsy.

Surgical treatment of refractory status epilepticus in children

“…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.…”

“…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.…”

Status Epilepticus in the PICU: Quieting the Storm

“…Finally, when medical therapy fails, epilepsy surgery may be considered for carefully chosen candidates. Candidates can include those with focal cortical dysplasia or patients with lateralized lesions, such as Rasmussen's encephalitis [63][64][65]. In addition, implantation of a vagal nerve stimulator has been reported in the preceding days prior to EEG normalization and being able to wean from suppressive medications in a 6-year-old with RSE [66].…”

Refractory status epilepticus

“…Zwei retrospektiven Studien untersuchten 33 Patienten im Alter von 2 Wochen bis 14 Jahren [1,88]. In der ersten Studie zeigten 8 von 10 Kindern mit fokalem SE über 2 Wochen bis zu 4 Monaten übereinstimmende Befunde im MRT und EEG [1].…”

“…In der ersten Studie zeigten 8 von 10 Kindern mit fokalem SE über 2 Wochen bis zu 4 Monaten übereinstimmende Befunde im MRT und EEG [1]. Nach funktioneller Hemisphärektomie (n=6), frontoparietaler Resektion (n=3) oder temporookzipitaler Resektion (n=1) konnte der SE in allen Fällen unterbrochen werden, und 7 Kinder blieben während der Nachbeobachtungszeit (im Mittel 7 Monate) anfallsfrei.…”