Outcome of emergency neurosurgery in patients with refractory and super-refractory status epilepticus: a systematic review and individual participant data meta-analysis

Refractory (RSE) and super-refractory status epilepticus (SRSE) are serious neurological conditions requiring aggressive management. Beyond anesthetic agents, there is a lack of evidence guiding management in these patients. This systematic review and individual participant data meta-analysis (IPDMA...

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Bibliographic Details
Published in:Frontiers in neurology 2024-05, Vol.15, p.1403266
Main Authors: Niazi, Farbod, Han, Aline, Stamm, Lauren, Shlobin, Nathan A, Korman, Catherine, Hoang, Thien S, Kielian, Agnieszka, Du Pont-Thibodeau, Genevieve, Ducharme Crevier, Laurence, Major, Philippe, Nguyen, Dang K, Bouthillier, Alain, Ibrahim, George M, Fallah, Aria, Hadjinicolaou, Aristides, Weil, Alexander G
Format: Article
Language:English
Subjects:
epilepsy surgery
Neurology
neuromodulation
refractory status epilepctius (RSE)
status epilepticus
super refractory status epilepticus (SRSE)
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Summary:Refractory (RSE) and super-refractory status epilepticus (SRSE) are serious neurological conditions requiring aggressive management. Beyond anesthetic agents, there is a lack of evidence guiding management in these patients. This systematic review and individual participant data meta-analysis (IPDMA) seeks to evaluate and compare the currently available surgical techniques for the acute treatment of RSE and SRSE. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Individual Participant Data (PRISMA-IPD). Only patients who underwent surgery while in RSE and SRSE were included. Descriptive statistics were used to compare various subgroups. Multivariable logistic regression models were constructed to identify predictors of status epilepticus (SE) cessation, long-term overall seizure freedom, and favorable functional outcome (i.e., modified Rankin score of 0-2) at last follow-up. A total of 87 studies including 161 participants were included. Resective surgery tended to achieve better SE cessation rate (93.9%) compared to non-resective techniques (83.9%), but this did not reach significance (  = 0.071). Resective techniques were also more likely to achieve seizure freedom (69.1% vs. 34.4%,  = 
ISSN:1664-2295
1664-2295
DOI:10.3389/fneur.2024.1403266