Surgical treatment of refractory status epilepticus in children

Bhatia, Sanjiv; Ahmad, Faiz U.; Miller, Ian; Ragheb, John; Morrison, Glenn; Jayakar, Prasanna; Duchowny, Michael

doi:10.3171/2013.7.peds1388

Cited by 24 publications

(19 citation statements)

References 35 publications

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“…Final outcome was seizure freedom (Engel Class I) in 7 patients, 90% seizure reduction (Engel Class II) in 4 patients, and persistent seizures in 4 patients (Engel Class III or IV). The authors concluded that SPECT is especially useful as it guided the invasive monitoring and surgical resections in 10/12 patients [26].…”

Section: Discussionmentioning

confidence: 99%

Successful surgical management of New Onset Refractory Status Epilepticus (NORSE) presenting with gelastic seizures in a 3 year old girl

Marashly

Lew

Koop

2017

Epilepsy & Behavior Case Reports

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Gelastic seizures (GS) are typically associated with hypothalamic hamartomas and present during childhood. However it is now known that GS can be found in focal epilepsies arising from other regions in the brain, including mesial and neocortical frontal, temporal and parietal regions.GS have rarely been described as the presenting manifestation of New Onset Refractory Status Epilepticus (NORSE). In this article we describe a previously healthy 3-year-old who presented with an explosive onset of GS that were refractory to multiple anti-seizure medications. These seizures arose from the right frontal region. An extensive metabolic and immunological evaluation was negative. Her brain magnetic resonance imaging (MRI) was negative, however the Positron Emission Tomography (PET) scan showed a hypermetabolic region in the right frontal inferior gyrus.She underwent a depth electrode evaluation that revealed a widespread irritative zone involving the PET “lesion” as well as mesial and neocortical regions in the right frontal lobe. The seizure onset zone was widespread and non-localizable. However the GS were associated with a clear ictal epileptiform discharge on invasive EEG arising from the depth of the superior frontal gyrus, which was not overlapping with the PET hypermetabolic region. She underwent a right frontal lobectomy sparing the primary motor region in the pre-central gyrus. She has remained seizure free for 15 months since. The pathological analysis showed focal cortical dysplasia type II in the region of the PET scan hypermetabolism. This case expands the clinical spectrum of GS to include cases of NORSE. Additionally the case highlights the role of resective surgery in GS presenting as NORSE and the potentially excellent outcome that can be achieved by early intervention.

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Section: Discussionmentioning

confidence: 99%

Successful surgical management of New Onset Refractory Status Epilepticus (NORSE) presenting with gelastic seizures in a 3 year old girl

Marashly

Lew

Koop

2017

Epilepsy & Behavior Case Reports

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“…One case series of 15 children with RSE who underwent surgical procedures reported that all had seizure control ranging from seizure freedom to substantial reductions, allowing transition out of the ICU. 128 Vagus nerve stimulation has been reported effective in several case reports, but efficacy generally occurs over a prolonged period.…”

Section: Refractory Status Epilepticusmentioning

confidence: 99%

Status Epilepticus and Refractory Status Epilepticus Management

Abend¹,

Bearden²,

Helbig³

et al. 2014

Seminars in Pediatric Neurology

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Status epilepticus (SE) describes persistent or recurring seizures without a return to baseline mental status, and is a common neurologic emergency. SE can occur in the context of epilepsy or may be symptomatic of a wide range of underlying etiologies. The clinician’s aim is to rapidly institute care that simultaneously stabilizes the patient medically, identifies and manages any precipitant conditions, and terminates seizures. Seizure management involves “emergent” treatment with benzodiazepines followed by “urgent” therapy with other anti-seizure medications. If seizures persist then refractory SE is diagnosed and management options include additional anti-seizure medications or infusions of midazolam or pentobarbital. This paper reviews the management of pediatric SE and RSE.

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“…A case series of 15 children with RSE who underwent surgical procedures reported that all had seizure control ranging from seizure freedom to substantial reductions, allowing transition out of the ICU. [70][Class IV]…”

Section: Other Therapiesmentioning

confidence: 99%

Management of Pediatric Status Epilepticus

Abend

Loddenkemper

2014

Curr Treat Options Neurol

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Opinion Statement Status epilepticus (SE) is a medical emergency consisting of persistent or recurring seizures without a return to baseline mental status. SE is not a single entity, but can be divided into subtypes based on seizure types and underlying etiologies. Management should be implemented rapidly and based on continuously reassessed care pathways. The aim is to terminate seizures while simultaneously identifying and managing precipitant conditions. Seizure management involves “emergent” treatment with benzodiazepines (lorazepam intravenously, midazolam intramuscularly, or diazepam rectally) followed by “urgent” therapy (phenytoin/fosphenytoin, phenobarbital, levetiracetam or valproate sodium). If seizures persist, “refractory” treatments include infusions of midazolam or pentobarbital. Prognosis is dependent on the underlying etiology and seizure persistence. This paper reviews the current management options and strategies for pediatric convulsive status epilepticus.

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Surgical treatment of refractory status epilepticus in children

Cited by 24 publications

References 35 publications

Successful surgical management of New Onset Refractory Status Epilepticus (NORSE) presenting with gelastic seizures in a 3 year old girl

Successful surgical management of New Onset Refractory Status Epilepticus (NORSE) presenting with gelastic seizures in a 3 year old girl

Status Epilepticus and Refractory Status Epilepticus Management

Management of Pediatric Status Epilepticus

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