Surgical treatment of status epilepticus: A palliative approach

Abstract

SUMMARYAlthough status epilepticus (SE) does not resemble a domain for neurosurgical indications in single occasions, a microneurosurgical procedure in patients with catastrophic epilepsy and status epilepticus should be considered as an ultimate ratiochoice in these patients. From a personal series of >600 epilepsy surgery procedures in a period from August 1, 1993 until March 13, 2013, 22 patients were identified with catastrophic epilepsy and all of them with at least one episode of status epilepticus. Five of the patients had surgery under ongoing status epilepticus. Twelve patients became seizure-free, two patients had >90% seizure reduction, seven patients >50% seizure reduction, and one patient was unchanged. No surgery-related complications in terms of permanent morbidity were ascertained in the presented series. In the subgroup of the five patients operated in the acute phase of SE one patient became seizure-free (Engel class. I), one showed Engel class II, two Engel class III, and one Engel class IV with no worthwhile improvement. Patients with catastrophic epilepsy including status epilepticus can benefit from resective epilepsy surgery, even with incomplete resection of the epileptogenic lesion.

Unexpected Aphasia following Right Temporal Lobectomy as Treatment of Recurrent Super-Refractory Status Epilepticus

“…There are 17 previously reported cases of resective surgery in the setting of SRSE, with 16 showing improvement in seizures after surgery; 7 became seizure free and 1 became free of disabling seizures (Engel class 1 [ 16 ]) (Table 1 ). Limited data from these cases suggest that surgery may be an effective method of treatment in appropriately selected cases.…”

“…Including the following case, resection has been reported in 18 cases of SRSE [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. The functional outcome is typically good, with hemiparesis being the most commonly reported postoperative complication [ 6 , 10 , 17 ].…”

Status Epilepticus in the Emergency Department, Part 2: Treatment

“…28 Vagus nerve stimulation, induced hypothermia, transcranial magnetic stimulation, and neurosurgical intervention have all been attempted with varying degrees of success in select patients. 29…”

Review and update of the Hong Kong Epilepsy Guideline on status epilepticus

“…49 Other management modalities that include hypothermia, electroconvulsive therapy, and epilepsy surgery are still under investigation with variable success rate. [50][51][52] An updated algorithm for the overall management of SE is summarised in the Figure. …”