Abstracts

Rationale: Medically refractory status epilepticus (MRSE) is a devastating neurological condition with high morbidity and mortality. Urgent resective surgery has been regarded as a palliative approach. Current literature is limited to small case series with heterogenous populations and variable surgical protocols.

Methods: We systematically searched our database from 1/1/2012 to 4/16/2021. Medical records were reviewed with the aim to describe etiology of MRSE, relevant clinical details, and outcomes (seizure freedom and mortality). The study received approval from the Institutional Review Board.

Results: Our series identified eight patients who underwent resective surgeries for MRSE. Mean age was 56 (28 to 77). Magnetic resonance imaging (MRI) lesions were noted in five out of eight patients; Two patients with lesions related to previously resected brain tumors (meningioma, oligodendroglioma), two patients had newly diagnosed lesions (glioblastoma multiforme (GBM), metastatic melanoma), and one patient had a previously evacuated intraparenchymal hematoma. All patients were refractory to a combination of four to seven anti-seizure medications (ASM) (mean of 5.6) and had evidence of status epilepticus (SE) on continuous electroencephalography (EEG), five of which were on one or more anesthetic medication (midazolam, propofol, pentobarbital, or ketamine). The mean duration from admission to surgery was 15.8 days (3 to 36 days) with a mean total hospital stay of 39 days (14 to 76 days). Intraoperative pre and post-resection electrocortigography (ECoG) were performed in five patients using surface grids and/or depth electrodes. Among the three MRI negative cases, one patient with cryptogenic /multifocal epilepsy underwent extension of prior corpus callosotomy and two patients had resection guided by scalp EEG and ECoG. Post-operatively, all patients had resolution of MRSE, five of which had no further seizures during the hospital course, one patient with breakthrough seizures successfully controlled with ASM adjustments, and two patients had significant reduction in seizure burden. Among the five patients with seizure freedom, four had MRI lesions. Seven out of eight patients were discharged to rehabilitation on two to six ASMs (mean of 4.1) and one patient developed cardiac arrest and expired. Two out of the seven patients later developed medical complications and expired less than two months after discharge. One patient passed away a year following discharge due to GBM recurrence. In the remaining four patients, two were seizure free on the last follow up (9 and 17 months).

Conclusions: In patients with MRSE, resective surgery can be a valuable option with proper patient selection. The presence of an identifiable lesion may offer a favorable outcome in terms of seizure freedom. Larger prospective studies are needed to further identify factors correlating with better outcomes and to aid in early selection of candidates.

Funding: Please list any funding that was received in support of this abstract.: None.