title: Surgical treatment of refractory status epilepticus in children: clinical article.
abstract: OBJECTIVE
  Refractory status epilepticus (RSE) is a life-threatening neurological emergency associated with high morbidity and mortality. Affected patients often require prolonged intensive care and can suffer multiple complications. Surgical intervention to control RSE is rarely used but can obviate the risks of prolonged seizures and intensive care treatment. Authors of the present study analyzed their experience with the surgical management of patients suffering from RSE.
  
  
  METHODS
  The Epilepsy Surgery Database at Miami Children's Hospital was reviewed for patients who had undergone surgery for RSE. Clinical presentation, electrophysiological profile, radiological data, surgical details, and postoperative course were evaluated.
  
  
  RESULTS
  Between 1990 and 2012, 15 patients underwent surgery for uncontrolled seizures despite high-dose medical suppressive therapy. The mean preoperative duration of status epilepticus was 8 weeks. Ictal SPECT and FDG-PET imaging in conjunction with intraoperative electrophysiological studies helped to outline the extent of resection. Surgical intervention controlled seizures in all patients and facilitated the transition out of intensive care. Adverse events related to a prolonged intensive care unit stay included sepsis and respiratory complications. Four patients had worsened neurological function, developing hemiparesis and dysphasia. There was no operative mortality.
  
  
  CONCLUSIONS
  Surgical intervention can successfully control refractory partial status epilepticus, prevent associated morbidity, and decrease intensive care unit stay. Ictal SPECT and PET are valuable in guiding resection.
authors: Departments of Neurological Surgery and.
authors: Sanjiv
authors: S
authors: Bhatia
authors: Faiz
authors: F
authors: Ahmad
authors: Ian
authors: I
authors: Miller
authors: John
authors: J
authors: Ragheb
authors: Glenn
authors: G
authors: Morrison
authors: Prasanna
authors: P
authors: Jayakar
authors: Michael
authors: M
authors: Duchowny
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D004351:Drug Resistance; D004569:Electroencephalography; D005260:Female; D005431:Florida / Q000453:epidemiology; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications / Q000601:surgery; D013226:Status Epilepticus / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18