Urgent Surgical Interventions for Medically Refractory and Super Refractory Status Epilepticus
Abstract number :
2.295
Submission category :
9. Surgery / 9C. All Ages
Year :
2022
Submission ID :
2204946
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Derrick Barnagian, B.S. – University of Pittsburgh School of Medicine; Mohamed Elrefaey, MD – SUNY Upstate Medical University; Yajing Xiong, MD – University of Pittsburgh Medical Center; Emily In, BS – University of Pittsburgh School of Medicine; James Castellano, MD, PhD – University of Pittsburgh Medical Center; Jorge Gonzalez-Martinez, MD, PhD – University of Pittsburgh Medical Center; Anto Bagic, MD, PhD – University of Pittsburgh Medical Center; Niravkumar Barot, MD, MPH – University of Pittsburgh Medical Center
Rationale: Status epilepticus (SE) is a neurological emergency requiring prompt evaluation and treatment to prevent significant morbidity and mortality. Refractory status epilepticus (RSE) is a subtype of SE that is resistant to first and second-line therapies. Super-refractory status epilepticus (SRSE) is defined as RSE that persists or recurs 24 hours or more after the initiation of anesthetic therapy. Urgent epilepsy surgery is a treatment option for patients with RSE and SRSE, however, data on efficacy and safety are limited. We performed a systematic review of the literature on patients with RSE and SRSE that underwent an acute surgical intervention.
Methods: We performed a literature search of Medline, PubMed, Embase, and Cochrane to include all existing published literature until August 2021. This review was conducted according to PRISMA guidelines and the protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). Four reviewers screened citations, abstracts, and manuscripts independently with a senior reviewer resolving any discrepancies. Extracted data including demographics of the patients, types of epilepsy, EEG results, lesions related to epilepsy, types of intervention, and outcomes after intervention. Our primary outcome was the mean percentage resolution of status epilepticus and our secondary outcome was the percentage with seizure freedom.
Results: A total of 75 patients were identified who underwent acute surgical intervention for RSE/SRSE. Mean age was 22.1 (range, 12 days - 66 years) and out of the 75 patients, 37 were females. The surgeries performed were classified as 65% (49/75) focal resection, 28% (21/75) disconnective, and 7% (5/75) subpial transections. The mean duration from admission to surgery was 35.5 days (range, 4-180), with an average of 4.7 (n= 50) anticonvulsant drugs and 2.1 (n= 42) IV anesthetics drugs administered prior to the surgical intervention. Of the etiologies, 44% (33/75) were malformations of cortical development, 25% (19/75) inflammatory, 12% (9/75) unknown, 7% (5/75) vascular, 5% (4/75) genetic, 4% (3/75) neoplasms, 1.5% (1/75) post-traumatic, and 1.5% (1/75) infectious. Cessation of SE occurred in 96% (74/75) of the patients, while one patient had severe medical deterioration after the surgery that resulted in death. The mean follow-up duration was 19.8 months (range, 1-96), and during the last follow-up, 58.6% (44/75) of the patients were seizure free (Engel Class 1).
Conclusions: Acute surgical intervention appears to be a very effective treatment of refractory and super refractory status epilepticus. Further studies are needed to assess the generalizability of these findings.
Funding: None
Surgery