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Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Role of epilepsy surgery in refractory status epilepticus in children
Sujit A Jagtap1, Nilesh Kurwale2, Sandeep Patil2
1Bharati Vidyapeeth Medical College, Pune, India; Deenanath Mangeshkar Hospital and Research Centre, Pune, India.
Insights
Emergency epilepsy surgery (ES) effectively treats refractory status epilepticus (SE) in children with structural brain abnormalities when medical treatments fail. This study shows positive outcomes for pediatric patients undergoing ES for intractable SE.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Status epilepticus (SE) is a critical neurological emergency, with a significant portion of patients developing refractory SE (RSE) unresponsive to standard treatments.
- The efficacy of epilepsy surgery (ES) for RSE remains under-investigated, with limited evidence from case reports and small series.
- Understanding the clinical presentation, imaging findings, and outcomes of RSE patients undergoing ES is crucial for treatment planning.
Purpose of the Study:
- To evaluate the effectiveness of emergency epilepsy surgery (ES) in children with refractory status epilepticus (RSE).
- To analyze the clinical characteristics, neuroimaging findings, and surgical outcomes in pediatric patients with RSE undergoing ES.
- To determine the suitability of ES as a treatment option for pediatric RSE unresponsive to medical management.
Main Methods:
- Retrospective analysis of pediatric patients diagnosed with SE who did not respond to escalating medical therapy.
- Inclusion criteria: Patients with SE, failure of medical treatment (including pharmacological suppression), and subsequent ES.
- Surgical procedures included hemispherotomy, focal cortical dysplasia resection, and hemispheric disconnection.
Main Results:
- Ten children (7 boys, 3 girls; age 6 months–14 years) with RSE underwent emergency ES.
- Underlying pathologies included hemimegalencephaly, focal cortical dysplasia, Rasmussen's encephalitis, and porencephalic cysts.
- Nine out of ten patients achieved excellent seizure control (Engel I outcome), with one patient showing significant improvement (Engel IIIa) at a mean follow-up of 31 months.
Conclusions:
- Emergency epilepsy surgery is a viable and effective therapeutic strategy for pediatric refractory status epilepticus in cases with identifiable structural brain lesions.
- Children with RSE and focal or hemispheric abnormalities on MRI, correlating with clinical and/or EEG findings, are strong candidates for surgical intervention.
- ES can lead to significant seizure reduction or elimination in pediatric RSE patients refractory to medical treatments.
Introduction:
Status epilepticus (SE) is one of the most common medical emergencies, requiring urgent treatment; nearly 30 % patients develop refractory SE. The role of epilepsy surgery (ES) for refractory SE however remains unclear with empirical evidence limited to single case reports and small case series. The aim of the present study was to determine the clinical presentation, imaging characteristics and outcome of children with refractory SE who underwent emergency ES for refractory SE.
Material And Method:
Patients who had SE, failed to respond to escalating medical treatment of SE with/ without pharmacological suppression therapy, and eventually underwent ES were included.
Results:
There were ten children, 7 boys and 3 girls (range 6 months to 14 years). The age of onset of epilepsy varied from day 2 of life to 12.8 years. The duration of SE prior to surgery was 2-6 days (mean 3.7 days). Four patients had hemimegalencephaly, 3 had focal cortical dysplasia, 2 had Rasmussen's encephalitis, and one had hemispheric porencephalic cyst. The time interval between onset of seizures and ES ranged from 2 months to 8 years (mean 3.1 year). Seven patients underwent hemispherotomy, resection of dysplasia in two and temporo-parieto-occipital disconnection in one. Nine had Engel I outcome and Engel IIIa in one, at follow up of 12-44 months (mean 31 months).
Conclusion:
Emergency ES is an effective treatment option for termination of refractory SE in children with structural pathology, after failure of medical treatment. Patients with refractory SE with focal or hemispheric structural abnormality on MRI, and concordant semiology with/without concordant EEG can be surgical candidates with or without invasive monitoring.
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