Michael McGinity1, Nicholas Andrade2, Kameel Karkar3, Jean-Louis Caron4, Charles Szabó5, Alexander Papanastassiou4. 1. Department of Neurosurgery, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA. Electronic address: McGinity@uthscsa.edu. 2. Department of Neurosurgery, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA. 3. Department of Neurology, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA; South Texas Comprehensive Epilepsy Center, San Antonio, Texas, USA. 4. Department of Neurosurgery, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA; South Texas Comprehensive Epilepsy Center, San Antonio, Texas, USA. 5. Department of Neurosurgery, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA; Department of Neurology, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA; South Texas Comprehensive Epilepsy Center, San Antonio, Texas, USA.
Abstract
BACKGROUND: Status epilepticus (SE) is a medical emergency, as deleterious long-term effects are well known. Medically induced burst suppression is often required if first-line and second-line treatments fail. Surgical intervention can be considered in some patients after prolonged treatment failure of medically induced coma. Multiple surgical options for terminating SE have been demonstrated in the literature, with only 2 reports including hemispherectomy in adults. CASE DESCRIPTION: We present 2 cases of adults with refractory SE who failed more conservative medical/surgical treatment but responded to functional hemispherectomy. Pertinent electroencephalography and imaging findings are discussed. In addition, all previously published pediatric and adult cases are briefly reviewed. CONCLUSIONS: Functional hemispherectomy can be considered in patients, including adults, with super-refractory SE and diffuse hemispheric onset. We report acceptable outcomes and quality of life in our 2 patients.
BACKGROUND:Status epilepticus (SE) is a medical emergency, as deleterious long-term effects are well known. Medically induced burst suppression is often required if first-line and second-line treatments fail. Surgical intervention can be considered in some patients after prolonged treatment failure of medically induced coma. Multiple surgical options for terminating SE have been demonstrated in the literature, with only 2 reports including hemispherectomy in adults. CASE DESCRIPTION: We present 2 cases of adults with refractory SE who failed more conservative medical/surgical treatment but responded to functional hemispherectomy. Pertinent electroencephalography and imaging findings are discussed. In addition, all previously published pediatric and adult cases are briefly reviewed. CONCLUSIONS: Functional hemispherectomy can be considered in patients, including adults, with super-refractory SE and diffuse hemispheric onset. We report acceptable outcomes and quality of life in our 2 patients.
Authors: C Ákos Szabó; Rachel Garvin; Shaheryar Hafeez; Ali Seifi; Linda Leary; Ratna Bhavaraju-Sanka; James M Henry; Alex M Papanastassiou Journal: Epilepsy Behav Case Rep Date: 2018-11-28