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

Abstract

Background: Super-refractory status epilepticus (SRSE) is a critical neurological condition with a high mortality rate. There are only limited data to direct the treatment in SRSE, and surgery has been reported to successfully stop SRSE. We present a case of recurrent SRSE treated with urgent right temporal lobectomy in a right-handed woman which potentially saved her life but resulted in crossed sensory aphasia. Case Description: A 61-year-old woman with a recent episode of prolonged focal SRSE due to right frontotemporal meningioma and hyperkalemia was admitted for recurrence of seizures that evolved to SRSE despite aggressive treatment with multiple fosphenytoin antiepileptic drugs (AEDs) and anesthetics. The patient underwent a right temporal lobectomy to remove the encephalomalacic and gliotic tissue around the meningioma that had been resected during a previous admission. Postoperatively the patient had a protracted course with modest improvement after stepwise reduction in her AEDs; however, her recovery unveiled a severe crossed aphasia. Conclusion: Resective surgery is an effective treatment option in the treatment of SRSE, although the recovery period can be protracted. Crossed aphasia after right temporal lobectomy should be considered in patients where it is not possible to complete a presurgical evaluation of higher cortical functions.

Good seizure outcome after focal resection surgery for super-refractory status epilepticus: Report of two cases

“…In both patients, the EEG findings during SRSE, that is, the "ictal" EEG findings, were the most useful for the preoperative identification of the epileptogenic region, confirming the previous reports. [7,17] In Patient 1, LPD was observed in the left frontotemporal region, and in Patient 2, repeated ictal discharges were consistently observed in the medial part of the left frontal region during the three SRSEs. Furthermore, in Patient 2, a high signal on DWI and focal hypermetabolism on FDG-PET were observed at the site corresponding to the ictal EEG findings.…”

“…[9] However, the actuality and usefulness of focal resection surgery have not been fully clarified, as limited reports are available. [4,7,9,17] We treated two SRSE patients who underwent resection surgery and obtained good seizure outcomes. Herein, we retrospectively analyze the clinical findings of these patients and discuss the usefulness of resection surgery for SRSE.…”

Surgical management of status epilepticus: A systematic review

“…Of the 81 studies in the literature that met the inclusion criteria, 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 …”

“…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.…”