Abstracts

Rationale: Refractory status epilepticus has a high morbi-mortality. There is not a universal protocol to treat it when it turns super refractory. The role of the surgery in this setting it is not well established and there are few reports about its use. Methods: We present three cases of refractory status epilepticus that were treated successfully with surgery. Results: Case 1: A patient with seizures starting at five days of birth, refractory since the beginning, who was operated at three months of age, after seven days of refractory status secondary to an extensive parieto-occipital cortical dysplasia type IIa. After the first surgery the patient recovered from status and after a second one he has been seizure free for a 2 year period. Case 2: A patient with an hemimegalencephaly, West syndrome and hemihypsarrhythmia with refractory seizures who at 6 months of age after 2 days of refractory status epilepticus were treated with functional hemispherectomy. After the surgery the patient recovered from status and with two years of follow up has been with only occasional seizures. Case 3: A 22 year-old patient who had cryptogenic refractory epilepsy with frequent epileptic status treated with callosotomy after 22 days of aggressive medical treatment. The patient improved with no more status and significant diminution of his seizure frequency after a 5 months follow-up.Conclusions: We present three different cases of refractory status epilepticus in spite of aggressive medical treatment; different surgical approaches were needed to allow recuperation in adverse settings. We conclude that although there are few reports about it, there is an important role of resective and desconnective neurosurgery as a second line treatment for super refractory status epilepticus in selected patients as a rescue measure.