title: Status epilepticus and frequent seizures: incidence and clinical characteristics in pediatric epilepsy surgery patients.
abstract: OBJECTIVE
  The literature suggests that pediatric epilepsy surgery cases that present in status epilepticus (SE) are an unusual occurrence. However, this concept is based on case reports, and the incidence and clinical characteristics of these patients have not been systematically assessed.
  
  
  METHODS
  The cohort consisted of resective epilepsy surgery cases from 2000 to 2005 (n = 115), and they were classified as presenting with continuous SE requiring medical suppression therapy (n = 6) or intermittent SE (greater than 3 seizures/hour; n = 17). The SE categories were compared with extratemporal surgery patients without SE (non-SE; n = 64) for differences in clinical variables abstracted from the medical record.
  
  
  RESULTS
  Continuous SE was noted in 5% and intermittent SE in 15% of resective surgery cases, and all had extratemporal cortical involvement. Compared with continuous SE and non-SE cases, intermittent SE patients were younger at surgery with shorter duration of seizures, and had an increased incidence of active infantile spasms during video scalp EEG monitoring. Compared with non-SE cases, the continuous and intermittent SE groups required a larger number of antiepileptic medications presurgery and 6-months postsurgery, underwent hemispherectomy more frequently, and had an increased incidence of hemimegalencephaly and Rasmussen encephalitis and a lower occurrence of infarct/ischemia and infectious etiologies. Seizure control was over 71% up to 2 years postsurgery, and there were no differences between patient groups. Finally, seizure frequency per hour was greater in continuous SE cases compared with the intermittent SE group.
  
  
  CONCLUSIONS
  Children presenting with continuous or intermittent SE are not rare in pediatric epilepsy surgery centers, and such cases are more commonly associated with infantile spasms, Rasmussen's syndrome, and hemimegalencephaly pathologies. Seizure outcome after surgery was not altered in pediatric patients because they had presented with continuous or intermittent SE.
authors.affiliation: Division of Pediatric Neurology, UCLA Medical Center, Los Angeles, CA 90095, USA. skoh@mednet.ucla.edu
authors.forename: Susan
authors.initials: S
authors.lastname: Koh
authors.forename: Gary W
authors.initials: GW
authors.lastname: Mathern
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Glasser
authors.forename: Joyce Y
authors.initials: JY
authors.lastname: Wu
authors.forename: W Donald
authors.initials: WD
authors.lastname: Shields
authors.forename: Rinat
authors.initials: R
authors.lastname: Jonas
authors.forename: Sue
authors.initials: S
authors.lastname: Yudovin
authors.forename: Carlos
authors.initials: C
authors.lastname: Cepeda
authors.forename: Noriko
authors.initials: N
authors.lastname: Salamon
authors.forename: Harry V
authors.initials: HV
authors.lastname: Vinters
authors.forename: Raman
authors.initials: R
authors.lastname: Sankar
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000002:abnormalities; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D004569:Electroencephalography; D004660:Encephalitis / Q000150:complications / Q000453:epidemiology; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D015994:Incidence; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013036:Spasms, Infantile / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000927:Anticonvulsants