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Urgent, resective surgery for medically refractory, convulsive status epilepticus

Dewi V Schrader1, Paul Steinbok, Mary Connolly

  • 1Division of Pediatric Neurology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.

European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society
|May 8, 2008
PubMed

Insights

Urgent resective surgery can successfully treat medically refractory convulsive status epilepticus in children. This intervention offers significant benefits, including seizure termination and improved patient outcomes.

Area of Science:

  • Pediatric Neurology
  • Neurosurgery
  • Epileptology

Background:

  • Refractory convulsive status epilepticus (RCSE) presents significant mortality and morbidity risks.
  • Medical therapies often fail to resolve RCSE, necessitating alternative treatment strategies.
  • Urgent resective surgery is a potential intervention for select pediatric cases.

Observation:

  • Three children with medically refractory convulsive status epilepticus underwent urgent resective surgery.
  • Etiologies included microdysgenesis, focal cortical dysplasia, and bilateral Rasmussen's syndrome with cortical dysplasia.
  • Surgery was performed between January 1992 and December 2005.

Findings:

  • Surgery terminated status epilepticus in two of the three cases.
  • All three patients were able to discontinue high-dose suppression therapy post-surgery.
  • Histopathological information aided in understanding disease nature and prognosis.

Implications:

  • Urgent resective surgery is a viable option for pediatric RCSE when medical management fails.
  • Surgical intervention can lead to seizure cessation and facilitate intensive care unit discharge.
  • Histopathological analysis from surgery provides crucial diagnostic and prognostic data.

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