title: Palliative functional hemispherectomy for treatment of refractory status epilepticus associated with Alpers' disease.
abstract: OBJECTIVE
  Palliative epilepsy surgery is considered for patients that would benefit from surgical therapy for intractable epilepsy but are not candidates for curative procedures. In many cases, the goals of therapy focus on improved quality of life more than seizure freedom. We discuss the use of epilepsy surgery for refractory status epilepticus, as well as the rationale and ethical considerations for employing a palliative procedure in otherwise fatal diseases.
  
  
  METHODS
  We present a child with Alpers' disease presenting with refractory status epilepticus which was treated with functional hemispherectomy after failure of multiple typical therapies. Hemispherectomy allowed for the child to be extubated and ultimately discharged to home with her family. Unfortunately, the child died several months later after developing new-onset liver failure in the setting of a viral illness.
  
  
  CONCLUSIONS
  Functional hemispherectomy was effective for the treatment of refractory status epilepticus in Alpers' disease. We believe that the procedure resulted in improved quality of life which was the primary outcome goal. Palliative procedures should be considered in diseases with ultimate fatal outcome when the short-term benefits outweigh the risks. The ethical aspects of treatment must be carefully considered to insure treatment is provided in the best interest of the patient.
authors.affiliation: University of North Texas Health Science Center, Fort Worth, TX, USA.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Lupashko
authors.forename: Saleem
authors.initials: S
authors.lastname: Malik
authors.forename: David
authors.initials: D
authors.lastname: Donahue
authors.forename: Angel
authors.initials: A
authors.lastname: Hernandez
authors.forename: M Scott
authors.initials: MS
authors.lastname: Perry
mesh_terms: D002675:Child, Preschool; D002549:Diffuse Cerebral Sclerosis of Schilder / Q000150:complications / Q000601:surgery*; D005260:Female; D038421:Hemispherectomy; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D013226:Status Epilepticus / Q000209:etiology / Q000601:surgery*