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Acute Resective Surgery for the Treatment of Refractory Status Epilepticus

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Abstract

Background

To identify the role of acute surgical intervention in the treatment of refractory status epilepticus (RSE).

Methods

Retrospective review of consecutive patients who underwent epilepsy surgery from 2006 to 2015 was done to identify cases where acute surgical intervention was employed for the treatment of RSE. In addition, the adult and pediatric RSE literature was reviewed for reports of surgical treatment of RSE.

Results

Nine patients, aged 20–68 years, with various etiologies were identified to have undergone acute surgical resection for the treatment of RSE, aided by electrocorticography. Patients required aggressive medical therapy with antiepileptic drugs and intravenous anesthetic drugs for 10–54 days and underwent extensive neurodiagnostic testing prior to resective surgery. Eight out of nine patients survived and five patients were seizure-free at the last follow-up. The literature revealed 13 adult and 48 pediatric cases where adequate historical detail was available for review and comparison.

Conclusions

We present the largest cohort of consecutive adult patients who underwent resective surgery in the setting of RSE. We also reveal that surgery can be efficacious in aborting status and in some can lead to long-term seizure freedom. Acute surgical intervention is a viable option in prolonged RSE and proper evaluation for such intervention should be conducted, although the timing and type of surgical intervention remain poorly defined.

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Acknowledgements

This study had no corporate sponsorship and was funded at the departmental level.

Authors’ contributions

MMB took part in acquisition, analysis and interpretation of data, study supervision, and critical revision of manuscript for intellectual content. KS and MD carried out acquisition and analysis of data. WJK performed acquisition, analysis and interpretation of data. SM and AKS were involved in study concept and design, critical revision of manuscript for intellectual content.

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Authors and Affiliations

  1. Division of Epilepsy, Department of Neurology, Wayne State University School of Medicine, 4201 St Antoine, 8C UHC, Detroit, MI, 48201, USA

    Maysaa Merhi Basha, Kushak Suchdev, William J. Kupsky & Aashit K. Shah

  2. Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA

    Monica Dhakar

  3. Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA

    William J. Kupsky

  4. Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA

    Sandeep Mittal

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  1. Maysaa Merhi Basha
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Correspondence to Maysaa Merhi Basha.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. The study was approved by the local institutional review board.

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Basha, M.M., Suchdev, K., Dhakar, M. et al. Acute Resective Surgery for the Treatment of Refractory Status Epilepticus. Neurocrit Care 27, 370–380 (2017). https://doi.org/10.1007/s12028-017-0381-z

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  • DOI: https://doi.org/10.1007/s12028-017-0381-z

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