Role of epilepsy surgery in refractory status epilepticus in children

Jagtap, Sujit; Kurwale, Nilesh; Patil, Sandeep B.; Bapat, Deepa; Chitnis, Sonal; Thakor, Bina; Joshi, Amit; Deshmukh, Yogeshwari; Nilegaonkar, Sujit

doi:10.1016/j.eplepsyres.2021.106744

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…Of the 81 studies in the literature that met the inclusion criteria, 13–92 the majority (60) reported only one patient. The remaining studies characterized a variable number of patients, ranging from 2 to 20.…”

Section: Resultsmentioning

confidence: 99%

Surgical management of status epilepticus: A systematic review

Jha,

Blitz,

Chua

et al. 2024

Epilepsia Open

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Status Epilepticus (SE), unresponsive to medical management, is associated with high morbidity and mortality. Surgical management is typically considered in these refractory cases. The best surgical approach for affected patients remains unclear; however, given the lack of controlled trials exploring the role of surgery. We performed a systematic review according to PRIMSA guidelines, including case reports and series describing surgical interventions for patients in SE. Cases (157 patients, median age 12.9 years) were followed for a median of 12 months. Patients were in SE for a median of 21 days before undergoing procedures including: focal resection (36.9%), functional hemispherectomy (21%), lobar resection (12.7%), vagus nerve stimulation (VNS) (12.7%), deep brain stimulation (DBS) (6.4%), multiple subpial transection (MST) (3.8%), responsive neurostimulation (RNS) (1.9%), and cortical stimulator placement (1.27%), with 24 patients undergoing multiple procedures. Multiple SE semiologies were identified. 47.8% of patients had focal seizures, and 65% of patients had focal structural abnormalities on MRI. SE persisted for 36.8 ± 47.7 days prior to surgical intervention. SE terminated following surgery in 81.5%, terminated with additional adjuncts in 10.2%, continued in 1.9%, and was not specified in 6.4% of patients. Long‐term seizure outcomes were favorable, with the majority improved and 51% seizure‐free. Eight patients passed away in follow‐up, of which three were in SE. Seizures emerging from one hemisphere were both more likely to immediately terminate (OR 4.7) and lead to long‐term seizure‐free status (OR 3.9) compared to nonunilateral seizures. No other predictors, including seizure focality, SE duration, or choice of surgical procedure, were predictors of SE termination. Surgical treatment of SE can be effective in terminating SE and leading to sustained seizure freedom, with many different procedures showing efficacy if matched appropriately with SE semiology and etiology.Plain Language SummaryPatients with persistent seizures (Status Epilepticus) that do not stop following medications can be treated effectively with surgery. Here, we systematically review the entirety of existing literature on surgery for treating status epilepticus to better identify how and when surgery is used and what patients do after surgery.

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Section: Resultsmentioning

confidence: 99%

Surgical management of status epilepticus: A systematic review

Jha,

Blitz,

Chua

et al. 2024

Epilepsia Open

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“…While generally well tolerated, CC can result in disconnection syndromes which occur due to failure to transfer unilateral stimuli through the brain [23]. Other possible complications of CC include hemorrhage and infection, though these are rare.…”

Section: Discussionmentioning

confidence: 99%

Using magnetic resonance-guided laser interstitial thermal therapy corpus callosotomy to lateralize a seizure focus for staged surgical approach

Sheikh,

Miller,

Blake

et al. 2024

Explor Neurosci

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New onset refractory status epilepticus (NORSE) is an etiologically heterogeneous condition that is associated with high morbidity and mortality. NORSE is often refractory to medical management prompting a workup for epilepsy surgery. Because NORSE remains etiologically elusive in most cases, surgical evaluations are challenging, especially when the epileptogenic zone (EZ) is not easy to lateralize as can be seen in frontal lobe seizures. Lateralizing a frontal lobe EZ may be challenging due to bilateral synchrony from commissural connections through the corpus callosum and low spatiotemporal resolution of the scalp electroencephalography (EEG). We report a pediatric patient with NORSE presenting with focal impaired awareness seizures clustering into super refractory status epilepticus (SRSE). She required surgical intervention for the treatment of her seizures after failing therapeutic doses of antiseizure medications, anesthetic drips, immunomodulation with methylprednisolone, intravenous immunoglobulin and anakinra, and the ketogenic diet. Despite her semiology being focal, the seizures were not well lateralized on scalp EEG and during phase 2 stereo-EEG (sEEG). Anterior magnetic resonance-guided laser interstitial thermal therapy corpus callosotomy (MRgLITT CC) was performed in a multistage surgical approach to successfully lateralize the EZ with a left-lateralized ictal pattern seen after reimplantation of sEEG electrodes. Our case suggests that minimally invasive MRgLITT CC can be successfully used to lateralize an EZ in frontal lobe epilepsy and that epilepsy surgery should be considered in patients with NORSE with SRSE. We also demonstrate that laser interstitial thermal therapy (LITT), while not always resulting in seizure freedom, can sufficiently disrupt a network to abort status epilepticus and lead to seizure improvements.

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“…Invasive EEG recordings with intracranial electrodes are not typically applied as presurgical work-up in pediatric RSE patients [10,11,15,16] but intraoperative electrocorticography (ECoG) might…”

Section: Neuropsychological Evaluationmentioning

confidence: 99%

“…However, epilepsy surgery in the context of pediatric SE is rare. In two institutional series of 750 and 391 operated pediatric patients with epilepsy, only 15 and 10 patients (2.0 and 2.6%, respectively) underwent epilepsy surgery to treat RSE [10,11]. By contrast, a recent nationwide report in Germany reported not a single surgical case in a total cohort of 483 RSE patients [12].…”

mentioning

confidence: 93%

Epilepsiechirurgie beim therapierefraktären Status epilepticus des Kindesalters

Borggraefe,

Tacke,

Kunz

et al. 2023

Clin Epileptol

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The mainstay of status epilepticus (SE) treatment is pharmacotherapy with anti-seizure medications (ASM). In refractory status epilepticus (RSE), when additional ASM are not effective, high-dose suppressive therapy with either benzodiazepines, thiopental, phenobarbitone, or propofol is used to suppress clinical and EEG seizure activity. However, in selected eligible cases of RSE or in super-refractory cases, epilepsy surgery may be the treatment of choice to terminate SE. Here, we review epilepsy surgery including deep brain stimulation (DBS) for treatment for RSE with emphasis on special aspects of presurgical evaluation, patient selection, and outcome. We focus on surgical treatment options for patients in the acute phase of RSE, who have received high-dose suppressive therapy prior to surgery in the majority of the cases.

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Role of epilepsy surgery in refractory status epilepticus in children

Cited by 7 publications

References 19 publications

Surgical management of status epilepticus: A systematic review

Surgical management of status epilepticus: A systematic review

Using magnetic resonance-guided laser interstitial thermal therapy corpus callosotomy to lateralize a seizure focus for staged surgical approach

Epilepsiechirurgie beim therapierefraktären Status epilepticus des Kindesalters

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