Abstracts

Rationale: The rationale for this case study is to highlight the challenges and potential treatment options for patients with super refractory status epilepticus (SRSE), a serious medical emergency with high morbidity and mortality. The case study aims to discuss the effectiveness of urgent resective surgery as a treatment option for suitable patients who do not respond to coma therapy and are considered to have SRSE.



The literature on effective therapies for SRSE is limited, and there is a need to explore alternative treatment options beyond standard medical management. By presenting a specific case of SRSE and discussing the successful outcome of frontal cortectomy in controlling seizures, the case study provides valuable insights into the potential role of epilepsy surgery as a therapeutic option for SRSE patients.


Methods: we present a young woman who experienced super refractory status epilepticus (SRSE) unresponsive to multiple anti-seizure medications, including coma-inducing agents and intravenous immunoglobulin therapy. The patient's medical history revealed a seizure onset at age 14 following skin rash and gastrointestinal symptoms, with initial control achieved using levetiracetam and valproic acid. Despite subsequent treatment with various anti-seizure medications and sedative therapies, the seizures remained uncontrolled, leading to consideration of surgical intervention. A multidisciplinary team, including epileptologists, an epilepsy surgeon, neuroradiologist, and neuropsychologist, evaluated the patient's data, which consistently indicated right frontal origin of the seizures. Consequently, a right frontal cortisectomy was performed using intraoperative electrocorticography. The family was involved in the decision-making process and consented to the surgery. The patient underwent the procedure under general anesthesia and total intravenous anesthesia protocol. This case underscores the challenges of managing SRSE and highlights the critical role of a comprehensive approach, including advanced diagnostic modalities and timely surgical intervention in achieving favorable outcomes for patients with refractory epilepsy.

Results:

She was discharged from the hospital 1 month after her operation. She was seizure free for four months after the discharge, then she developed one generalized tonic clinic seizure after traveling and history of upper respiratory tract infection, but for the last 6 months, she was seizure free.

Conclusions: We present a case highlighting the potential outcome of Epilepsy surgery in super refractory status epilepticus SRSE. Early surgical intervention is a treatment option to be considered in SRSE. Criteria to select a patient for epilepsy surgery should include failure of standard medical treatment protocols for SE, definition of epileptogenic zones (EZ) by EEG, semiology, and neuroimaging studies & performance of epilepsy surgery by experienced neurosurgeons.

Funding: N/A