Abstracts

Over the years, case reports in the literature have suggested that a small percentage of patients with status epilepticus of focal origin may be successfully treated with resective surgery. The most common etiologies in reported cases are Rasmussen[apos]s encephalitis, cortical dysplasia and hemimegalancephaly., We reviewed our epilepsy surgery database since 1992 for cases where urgent resective surgery was performed for medically refractory status epilepticus., We reviewed a total of 205 surgeries for refractory epilepsy. Four patients had urgent surgery as treatment for refractory status epilepticus. Details of the study population are described in Table 1.The duration of status before surgery was from 14 to 45 days. MR imaging demonstrated cortical dysplasia in one patient, white matter abnormalities in another, and was normal in two. EEGs showed focal seizures originating from one hemisphere in three of the patients. In the patient with cortical dysplasia and Rasmussen[apos]s encephalitis, seizures were recorded independently from both hemispheres but arose most frequently from the left occipital area. Surgery was performed with the aim of terminating status. In follow up, three patients have developmental delay and one is making developmental progress. No patient had complications related to their surgery aside from the predicted neurological deficits such as hemiparesis., In our experience, the number of patients in true status epilepticus at the time of surgery was very low. Following surgery, three of four patients experienced resolution of status epilepticus and had a significant reduction in seizures; two patients were seizure free. In all cases, surgery provided a specific diagnosis that was invaluable in directing management.[table1],