Abstracts

Rationale: Surgical resection may be necessary to treat medically refractory status epilepticus. In status epilepticus with a lateralized multifocal or diffuse origin, hemispherectomy may be effective. To our knowledge, only one child has been reported to have undergone anatomic hemispherectomy for treatment of refractory status epilepticus. Methods: We report two adults who underwent functional hemispherectomy for refractory status epilepticus with good results. Results: RR is a 38 year-old man who presented with a six-year history of left hand and face clonic seizures, progressive left hemiparesis and a region of FLAIR hyperintensity in the right temporal lobe. After a nondiagnostic biopsy of this area, he developed epilepsia partialis continua, refractory to multiple medications including pentobarbital coma. He underwent intracranial electrode placement followed by functional hemispherectomy. Pathology was consistent with Rasmussen s encephalitis. Postoperatively he had no further clinical seizures, but EEG monitoring suggested subclinical seizures that were controlled with levetiracetam. He continues to be seizure free 35 months post-operatively. EH is a 48 year-old woman with remote prior right temporal and occipital lobectomies who presented in generalized status epilepticus due to noncompliance. After three weeks of treatment with AEDs including pentobarbital coma, she underwent implantation of grid and strip electrodes for seizure localization and resection. In the OR, grid and strip electrodes showed onset in the parietal lobe. Parietal lobe resection and multiple subpial transections of primary sensory cortex were performed. Status origin spread to her frontal lobe, so grid and strip electrodes were left in place for monitoring during consideration of functional hemispherectomy. Pathology showed cortical dysplasia. After a family meeting, she underwent right functional hemispherectomy. Post-operatively she was treated for fungal meningitis, and underwent ventriculoperitoneal shunt placement for hydrocephalus. She was subsequently treated for a delayed wound infection. She remains seizure free at 18 months follow-up. Conclusions: We conclude that in adults with refractory status epilepticus, functional hemispherectomy may have relatively good results, and should be considered as an option.