Surgical treatment of refractory status epilepticus in children

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

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Object. Refractory status epilepticus (RSE) is a life-threatening neurological emergency associated with high morbidity and mortality. Affected patients often require prolonged intensive care and can suffer multiple complications. Surgical intervention to control RSE is rarely used but can obviate the risks of prolonged seizures and intensive care treatment. Authors of the present study analyzed their experience with the surgical management of patients suffering from RSE. Methods. The Epilepsy Surgery Database at Miami Children's Hospital was reviewed for patients who had undergone surgery for RSE. Clinical presentation, electrophysiological profile, radiological data, surgical details, and postoperative course were evaluated. Results. Between 1990 and 2012, 15 patients underwent surgery for uncontrolled seizures despite high-dose medical suppressive therapy. The mean preoperative duration of status epilepticus was 8 weeks. Ictal SPECT and FDG-PET imaging in conjunction with intraoperative electrophysiological studies helped to outline the extent of resection. Surgical intervention controlled seizures in all patients and facilitated the transition out of intensive care. Adverse events related to a prolonged intensive care unit stay included sepsis and respiratory complications. Four patients had worsened neurological function, developing hemiparesis and dysphasia. There was no operative mortality. Conclusions. Surgical intervention can successfully control refractory partial status epilepticus, prevent associated morbidity, and decrease intensive care unit stay. Ictal SPECT and PET are valuable in guiding resection.

Original languageEnglish (US)
Pages (from-to)360-366
Number of pages7
JournalJournal of Neurosurgery: Pediatrics
Volume12
Issue number4
DOIs
StatePublished - Oct 1 2013

Keywords

  • Emergency
  • Epilepsy surgery
  • Intractable seizure
  • Refractory status epilepticus

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Pediatrics, Perinatology, and Child Health

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    Bhatia, S., Ahmad, F., Miller, I., Ragheb, J., Morrison, G., Jayakar, P., & Duchowny, M. (2013). Surgical treatment of refractory status epilepticus in children. Journal of Neurosurgery: Pediatrics, 12(4), 360-366. https://doi.org/10.3171/2013.7.PEDS1388