Role of epilepsy surgery in refractory status epilepticus in children

• Published in: Epilepsy research 2021-10, Vol.176, p.106744-106744, Article 106744
• Main Authors: Jagtap, Sujit A., Kurwale, Nilesh, Patil, Sandeep, Bapat, Deepa, Chitnis, Sonal, Thakor, Bina, Joshi, Aniruddha, Deshmukh, Yogeshwari, Nilegaonkar, Sujit
• Format: Article
• Language: English
• Subjects: Child; Drug Resistant Epilepsy - complications; Drug Resistant Epilepsy - diagnostic imaging; Drug Resistant Epilepsy - surgery; Electroencephalography - adverse effects; Epilepsy - drug therapy; Epilepsy surgery; Female; Hemimegalencephaly; Hemispherectomy - methods; Humans; Magnetic Resonance Imaging; Male; Malformations of Cortical Development - surgery; Rasmussen’s encephalitis; Retrospective Studies; Status epilepticus; Status Epilepticus - complications; Status Epilepticus - diagnostic imaging; Status Epilepticus - surgery; Treatment Outcome
• ISSN: 0920-1211; 1872-6844
• DOI: 10.1016/j.eplepsyres.2021.106744

•Patients with refractory status epilepticus (RSE) with structural abnormality can be surgical candidates.•The most common etiologies with RSE with emergency surgery are hemimegalencephaly, focal cortical dysplasia, or Rasmussen encephalitis.•Emergency epilepsy surgery is an effective treatment option for termination of RSE with structural pathology. Status epilepticus (SE) is one of the most common medical emergencies, requiring urgent treatment; nearly 30 % patients develop refractory SE. The role of epilepsy surgery (ES) for refractory SE however remains unclear with empirical evidence limited to single case reports and small case series. The aim of the present study was to determine the clinical presentation, imaging characteristics and outcome of children with refractory SE who underwent emergency ES for refractory SE. Patients who had SE, failed to respond to escalating medical treatment of SE with/ without pharmacological suppression therapy, and eventually underwent ES were included. There were ten children, 7 boys and 3 girls (range 6 months to 14 years). The age of onset of epilepsy varied from day 2 of life to 12.8 years. The duration of SE prior to surgery was 2–6 days (mean 3.7 days). Four patients had hemimegalencephaly, 3 had focal cortical dysplasia, 2 had Rasmussen’s encephalitis, and one had hemispheric porencephalic cyst. The time interval between onset of seizures and ES ranged from 2 months to 8 years (mean 3.1 year). Seven patients underwent hemispherotomy, resection of dysplasia in two and temporo-parieto-occipital disconnection in one. Nine had Engel I outcome and Engel IIIa in one, at follow up of 12–44 months (mean 31 months). Emergency ES is an effective treatment option for termination of refractory SE in children with structural pathology, after failure of medical treatment. Patients with refractory SE with focal or hemispheric structural abnormality on MRI, and concordant semiology with/without concordant EEG can be surgical candidates with or without invasive monitoring.