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Surgical Treatment for Acute Symptomatic Refractory Status Epilepticus: A Case Report

Divisions of Neurology The Hospital for Sick Children, Toronto, Ontario, Canada

Hiroshi Otsubo, MD

Divisions of Neurology The Hospital for Sick Children, Toronto, Ontario, Canada, hiroshi.otsubo{at}sickkids.ca

Katsumi Imai, MD

Divisions of Neurology The Hospital for Sick Children, Toronto, Ontario, Canada

Manohar Shroff, MD

Division of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada

Rohit Sharma, RET

Divisions of Neurology The Hospital for Sick Children, Toronto, Ontario, Canada

Sylvester H. Chuang, MD

Division of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada

Elizabeth Donner, FRCP(C)

Divisions of Neurology The Hospital for Sick Children, Toronto, Ontario, Canada

James Drake, MD

Division of Neurosurgery The Hospital for Sick Children, Toronto, Ontario, Canada

O. Carter Snead, III

A previously healthy 10-year-old boy developed generalized convulsive status epilepticus following a mild febrile illness. Prolonged video-electroencephalographic monitoring revealed frequent right hemispheric electrographic seizures that were refractory to high-dose suppressive therapy. Ictal and interictal magnetoencephalography demonstrated dipole sources projecting from the right mesial temporal region. Diffusion-weighted imaging showed restricted diffusion involving the right hippocampus. Right anterior temporal lobectomy resulted in cessation of status epilepticus. At 1-year follow-up, he attends regular school and has infrequent nocturnal seizures on chronic antiepileptic drug therapy. Surgical treatment should be considered to stop status epilepticus in selected cases of acute symptomatic refractory status epilepticus with no preexisting epilepsy or magnetic resonance imaging abnormalities and may avoid the complications associated with prolonged high-dose suppressive therapy.

Key Words: acute symptomatic refractory status epilepticus • magnetoencephalography • diffusion-weighted imaging • surgical treatment

Journal of Child Neurology, Vol. 22, No. 4, 435-439 (2007)
DOI: 10.1177/0883073807301929


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