Abstracts

BACKGROUND: There has been described only a few cases of untractable epileptic status with multifocal crisis of unknown etiology. Nearly 20 to 30% of epileptic patients are resistant to conventional antiepileptic drugs. Those patients are elictible to receive alternative therapies such as callosotomy to achieve epileptic control, reduce antiepileptic drugs consumption, hence limiting side effects, and improving patient s life quality. OBJECTIVE: To present a case report of a patient with cryptogenic catastrophic epileptic encephalopathy (CCEE) who was candidate to receive epileptic surgical treatment as an adjuvant therapy. KEY WORDS: epileptic status, callosotomy CASE REPORT: 6 years old male patient with a non-pathologic perinatal history, normal psychomotor development, who suddenly develops: fever, headache, asthenia, adynamia, sore throat and vomit. At the time of admission he had neurological deterioration characterized by somnolence and generalized tonic-clonic seizures. He was initially managed with PHT impregnation, but due to a lack of response he was induced to a barbituric coma with thiopental. His clinical evolution was inadequate because a persistent epileptic status. Many antiepileptic drugs were administered, such as: PB, Midazolam, VPA, VGB, Dexamethasone, LTG, CZP, ACTH, Propofol, LEV and TPM. Regardless of multidrug treatment, he continued with poor control of seizures and develops CCEE. EEG shows generalized spike-waves complexes, high-voltage slow waves, polyspike discharges paroxysms. Also he had several drug side effects. That s why he was selected to undergone surgical treatment and callosotomy was performed. Initially he presented clinical and electroencephalographic improvement. Nevertheless 72 hrs after surgery he develop partial motor seizures (almost 135 per day) coreoathetosic movements, multiple organ failure and finally he dies. The frontal cerebral cortex biopsy reports simple neuronal atrophy and serious extensive hypoxic changes with microglial activation. CONCLUTIONS: Epileptic status has an elevated morbi-mortality on pediatric patients. The secondary development of CCEE entails a lack of response to pharmacological l treatment. Callosotomy is an acceptable adjuvant treatment for this kind of patients. Regardless the employed therapy, CCEE has an elevated sequelae and mortality rates.