Efficacy of surgical treatment of de novo, adult-onset, cryptogenic, refractory focal status epilepticus.
BACKGROUND
There have been few published reports of successful surgical treatment of focal status epilepticus. Surgical intervention is considered a last resort after medical strategies have been exhausted.


OBJECTIVE
To report a case of an adult who was initially seen with de novo, medically refractory, cryptogenic focal status epilepticus and underwent resection of an electrographically defined portion of the left middle frontal gyrus with multiple subpial transections of the adjacent cortex resulting in termination of the electroclinical seizure activity.


METHODS
Report of a case of successful surgical treatment of cryptogenic focal status epilepticus.


METHODS
After an initial 35 days of oral antiepileptic drug therapy and subsequent 16 days of continuous electroencephalography-guided intravenous antiepileptic drug therapy in an intensive care unit setting, and after extensive preoperative and intraoperative characterization of the epileptogenic zone, a tailored resection of the left middle frontal gyrus with multiple subpial transections of the surrounding cortex was performed.


RESULTS
The restricted surgical resection and multiple subpial transections terminated the seizure activity. Neuropathological examination of the resected tissue revealed moderate inflammatory changes and a few abnormally located neurons without any definitive evidence of dysplasia, which was suspected preoperatively.


CONCLUSIONS
We suggest that focal cortical resection may be an appropriate intervention in medically refractory focal status epilepticus even when an overt structural etiology is not evident preoperatively and should be considered as an option at the onset of intractability.
Costello
Daniel J
DJ
Epilepsy Service, Department of Neurology, Massachusetts General Hospital, Boston 02114, USA. djcostello@partners.org
Simon
Mirela V
MV
Eskandar
Emad N
EN
Frosch
Matthew P
MP
Henninger
Heidi L
HL
Chiappa
Keith H
KH
Cole
Andrew J
AJ
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods; D013226:Status Epilepticus / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome
D000927:Anticonvulsants