Successful neurosurgical treatment of childhood complex partial status epilepticus with focal resection
Yu-tze Ng1, Howard L Kim, James W Wheless
1Texas Comprehensive Epilepsy Program, Department of Neurology, University of Texas-Houston Medical School, Houston, Texas, USA. y2ng@chw.edu
Insights
Complex partial status epilepticus in children can be challenging to treat. Urgent epilepsy surgery evaluation may be necessary for refractory cases, especially when occult focal cortical dysplasia is suspected.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neurosurgery
Background:
- Complex partial status epilepticus (CPSE) treatment remains controversial, often requiring intensive medical therapy or drug-induced coma.
- Refractory cases may not respond to standard treatments, necessitating alternative approaches.
Observation:
- A 4-year-old girl presented with CPSE and a history of cryptogenic partial-onset seizures.
- Despite normal MRI and failure of multiple medical therapies and multiple subpial transection (MST), her condition was refractory.
Findings:
- An urgent epilepsy surgery evaluation led to a focal cortical resection in the right mesial parietal region.
- The patient achieved complete seizure freedom for 2 years post-surgery with no significant neurological deficits.
Implications:
- This case highlights the importance of considering occult focal cortical dysplasia in pediatric nonconvulsive status epilepticus (NCSE).
- Prompt epilepsy surgery evaluation is crucial for children with NCSE unresponsive to medical management.
Abstract:
The treatment of complex partial status epilepticus continues to be controversial, especially with regard to the intensity of the treatment. Medical therapy and drug-induced coma are sometimes required. Rarely this may not be effective. A healthy 4-year old girl was first seen in complex partial status epilepticus. She had a 1-year history of cryptogenic partial-onset seizures. Detailed magnetic resonance imaging (MRI) studies were normal. Her course was refractory to multiple medical therapies and multiple subpial transection (MST). An urgent epilepsy surgery evaluation resulted in a focal cortical resection being performed over the right mesial parietal region with resultant seizure freedom and no significant neurologic deficit 2 years later. This patient illustrates the need to consider occult focal cortical dysplasia as a cause of nonconvulsive status epilepticus (NCSE) in children, and if it is not responsive to medical management, the utility of performing an urgent epilepsy surgery evaluation.
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