Urgent, resective surgery for medically refractory, convulsive status epilepticus

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.