Authors :
Presenting Author: Neela Zalmay, – Kern Medical Center
Kevin Dao, MD – Kern Medical Center; Christianne Heck, MD – University of Southern California; Jennifer Ipe, Research Associate – Kern Medical Center; Charles Liu, MD, PhD – University of Southern California; Britney Ly, Research Associate – Kern Medical Center; George Nune, MD – West Coast Neurology; Neela Zalmay, Research Associate – Kern Medical Center
Rationale:
Prolonged super-refractory status epilepticus (SRSE) is defined by the ILAE Task Force as SRSE lasting beyond seven days with ongoing anesthetic use. [4] Patients with persisting SRSE can also be treated with resective surgery or neuromodulation depending on clinical presentation, but not typically both. [2] We report a rare case of SRSE that was treated with initial resective surgery followed by vagal nerve stimulator (VNS) implantation. Residual persistent epilepsia partialia continua (EPC) was then controlled with Botox therapy (BoNT).
Methods: N/A
Results:
A 41-year-old female with remote history of focal epilepsy on oral anticoagulation therapy for DVT was brought to the ED in a coma with left focal motor status epilepticus (SE) due to right frontal intracerebral hematoma. Patient was started on lorazepam followed by levetiracetam, phenytoin, and lacosamide to terminate the focal SE. Propofol and midazolam were subsequently administered. An emergency craniotomy for evacuation of the hematoma was completed and the non-convulsive focal (SE) was resolved but the patient had residual EPC with preserved awareness at the time of discharge to an acute rehab facility. The patient again developed focal SE with impaired awareness and was sent to an academic center at which time she underwent ECOG-guided surgical resection of the residual epileptic focus surrounding the cavity of the prior hematoma evacuation. After unsuccessful weaning off sedation, the patient underwent VNS implantation that terminated the SE. The residual EPC was treated with three courses of BoNT resulting in no myoclonic jerks.
Conclusions:
Little literature exists describing a case of traumatic brain insult and acute onset of SE successfully treated with both surgical resection and VNS implantation followed by residual EPC that was later treated with BoNT. [3] This case highlights the individual and/or collective efficacy of surgical resection and VNS implantation as treatment for SRSE and residual EPC. Additionally, the case illustrates the positive effects of BoNT in residual EPC management. [1]
Funding:
None