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Published on: September 20, 2024
Surgical treatment of refractory status epilepticus in children: candidate selection and outcome
Martina Vendrame1, Tobias Loddenkemper
1Children's Hospital Boston, Boston, MA 02115, USA.
Insights
Epilepsy surgery offers a potential treatment for children with refractory status epilepticus (RSE). Surgical interventions like resections show promise, but further research is needed to optimize timing and patient selection for this pediatric epilepsy condition.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Refractory status epilepticus (RSE) in children presents significant treatment challenges.
- Current medical management for RSE is often insufficient, necessitating alternative therapeutic strategies.
Purpose of the Study:
- To evaluate the role and efficacy of surgical interventions for pediatric refractory status epilepticus.
- To explore various surgical approaches and their outcomes in managing RSE.
Main Methods:
- Review of surgical options including focal cortical resections, hemispherectomies, multiple subpial transections, corpus callosotomy, and vagal nerve stimulator implantation.
- Analysis of cases where electrographic and imaging data guided surgical decisions.
- Consideration of intraoperative electrocorticography for nonlesional pathologies.
Main Results:
- Resective surgery demonstrates immediate and long-term benefits when the epileptogenic focus is clearly identified.
- Surgery can be considered even without clear electrographic evidence if extensive pathology is present on MRI.
- Preliminary data suggests epilepsy surgery is a viable option for select pediatric RSE cases.
Conclusions:
- Epilepsy surgery is a promising alternative treatment for selected children with refractory status epilepticus.
- Further research is required to establish optimal surgical timing, intervention criteria, and prognostic factors for RSE.
Abstract:
Surgical treatment emerges as a therapeutic option for refractory status epilepticus (RSE) in children. Surgical approaches for RSE include focal cortical resections, hemispherectomies, multiple subpial transections, and rarely corpus callosotomy and vagal nerve stimulator implantation. Resective surgery has shown immediate- and long-term benefits in cases of definite localization of the epileptogenic focus by elecrographic and imaging data. Evidence of focal electrographic activity may not always be available during prolonged status. Nevertheless, resection may be an option in these cases if extensive, and confined pathology is seen on magnetic resonance imaging. On the contrary, electrographic localization may be complemented by intraoperative electrocorticography during multiple subpial transections in cases of nonlesional pathology. The optimal timing of surgery in eligible patients has been determined by concerns about medical intractability weighed against accumulating risks of RSE and the possible appearance of secondary epileptogenic zones caused by ongoing seizures. Overall, preliminary case series suggest that epilepsy surgery may be an alternative treatment option for selected children with RSE. Additional studies are needed to delineate timing and criteria for intervention as well as prognostic factors.
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