Abstracts

Status epilepticus continues to be a severe, potentially life-threatening disorder. Medical management remains the mainstay and at least the first three lines of treatment. Occasionally medical treatment does not work and neurosurgery should be an option, even though there have been very few reports on this modality of treatment. Five patients are described who presented with medically intractable status epilepticus, including two cases of epilepsia partialis continua and one case of status gelasticus that responded to focal resection. The patients were aged between four months and seven years of age. There were two boys. Three cases were clearly lesional (on MRI) with obvious [quot]targets[quot] for neurosurgical resection whilst the other two cases were initially non-lesional, making the surgery more challenging. One patient underwent a hemispherectomy, another resection of hypothalamic hamartoma, one patient had resection of her symptomatic cavernous malformation and the last two underwent non-lesional focal cortical resection (one following invasive monitoring). At latest follow-up with all of the patients (between nine months and four years), three were seizure-free (one off all antiepileptic drugs for more than two years) and the other two patients had [gt]90% seizure reduction. There were no mortalities or significant morbidity. One patient had a transient hemiparesis whilst another had residual left hemiparesis which was not worse than pre-hemispherectomy secondary to right hemispheric cortical dysplasia. Although neurosurgery will clearly never be a first-line treatment for status epilepticus, it should possibly be considered an earlier (e.g. third or fourth line) intervention/treatment rather than a [quot]last resort[quot]. In certain cases, neurosurgery can be and has been life saving. Focal cortical dysplasias and/or non-lesional cases do not have to mean poorer outcome. However, more elective epilepsy surgery cases may decrease the need for heroic surgical cases with status epilepticus.[table1]