Surgical Treatment of Refractory Status Epilepticus in Children: Candidate Selection and Outcome

Surgical treatment emerges as a therapeutic option for refractory status epilepticus (RSE) in children. Surgical approaches for RSE include focal cortical resections, hemispherectomies, multiple subpial transections, and rarely corpus callosotomy and vagal nerve stimulator implantation. Resective su...

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Bibliographic Details
Published in:Seminars in pediatric neurology 2010-09, Vol.17 (3), p.182-189
Main Authors: Vendrame, Martina, MD, PhD, Loddenkemper, Tobias, MD
Format: Article
Language:English
Subjects:
Brain - surgery
Child
Clinical Protocols
Diagnostic Imaging
Drug Resistance
Electroencephalography - methods
Humans
Neurology
Neurosurgical Procedures - adverse effects
Neurosurgical Procedures - methods
Patient Selection
Pediatrics
Status Epilepticus - surgery
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Summary:Surgical treatment emerges as a therapeutic option for refractory status epilepticus (RSE) in children. Surgical approaches for RSE include focal cortical resections, hemispherectomies, multiple subpial transections, and rarely corpus callosotomy and vagal nerve stimulator implantation. Resective surgery has shown immediate- and long-term benefits in cases of definite localization of the epileptogenic focus by elecrographic and imaging data. Evidence of focal electrographic activity may not always be available during prolonged status. Nevertheless, resection may be an option in these cases if extensive, and confined pathology is seen on magnetic resonance imaging. On the contrary, electrographic localization may be complemented by intraoperative electrocorticography during multiple subpial transections in cases of nonlesional pathology. The optimal timing of surgery in eligible patients has been determined by concerns about medical intractability weighed against accumulating risks of RSE and the possible appearance of secondary epileptogenic zones caused by ongoing seizures. Overall, preliminary case series suggest that epilepsy surgery may be an alternative treatment option for selected children with RSE. Additional studies are needed to delineate timing and criteria for intervention as well as prognostic factors.
ISSN:1071-9091
1558-0776
DOI:10.1016/j.spen.2010.06.011