title: Resective surgery in the treatment of super-refractory partial status epilepticus secondary to NMDAR antibody encephalitis.
abstract: BACKGROUND
  Anti-NMDAR encephalitis is an increasingly described clinical entity in children, comprising 40% of all cases. We present a case of super-refractory status epilepticus secondary to anti-NMDAR encephalitis treated with emergent resective surgery.
  
  
  METHODS
  A 7 years-old boy presented with progressive abnormal irritability. On the day after admission he had multiple seizures, characterized by head and eye version to the right. EEG revealed left parietal-occipital continuous paroxysmal activity. Anti-NMDAR antibodies were positive in CSF and serum. After almost 3 months in the Intensive Care Unit, in barbituric coma, and given the failure of all treatment regimens, a preoperative evaluation was conducted. Ictal SPECT showed significant hiperperfusion and brain FDG-PET a cortical hypometabolism in the left occipital lobe; a left occipital lobectomy was performed. In the next days it was possible to progressively suspend Thiopental. Currently, patient presents right homonymous hemianopsia, eats by his own hand but needs help in almost all other activities.
  
  
  CONCLUSIONS
  Status epilepticus (SE) in the setting of anti-NMDAR encephalitis is unusual but described. Whilst the role of surgery in the management of refractory focal epilepsy is established, it is seldom used in the treatment of SE. In the patient with refractory SE (RSE), awareness of surgery as a potentially life saving treatment is an important issue. To our knowledge, this is the first report of a partial RSE secondary to anti-NMDAR encephalitis treated with resective surgery and illustrates the need to consider anti-NMDAR encephalitis as a cause of super-refractory SE.
authors.affiliation: Neurology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Faculty of Health Sciences, University Fernando Pessoa, Portugal. Electronic address: pedrojgbarros@gmail.pt.
authors.forename: Pedro
authors.initials: P
authors.lastname: Barros
authors.affiliation: Pediatrics Department, Centro Hospitalar do Porto, Portugal.
authors.forename: Hernâni
authors.initials: H
authors.lastname: Brito
authors.affiliation: Pediatrics Intensive Care Department, Centro Hospitalar do Porto, Portugal.
authors.forename: Paula Cristina
authors.initials: PC
authors.lastname: Ferreira
authors.affiliation: Neurophysiology Department, Centro Hospitalar do Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Ramalheira
authors.affiliation: Neurophysiology Department, Centro Hospitalar do Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Lopes
authors.affiliation: Neurosurgery Department, Centro Hospitalar do Porto, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Rangel
authors.affiliation: Neuropediatrics Department, Centro Hospitalar do Porto, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Temudo
authors.affiliation: Neuropediatrics Department, Centro Hospitalar do Porto, Portugal.
authors.forename: Sónia
authors.initials: S
authors.lastname: Figueiroa
mesh_terms: D060426:Anti-N-Methyl-D-Aspartate Receptor Encephalitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001921:Brain / Q000473:pathology / Q000601:surgery*; D002648:Child; D004569:Electroencephalography / Q000379:methods; D006801:Humans; D008297:Male; D013226:Status Epilepticus / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome
keywords: Anti-NDMAR; Encephalitis; Lobectomy; Seizures; Status epilepticus; Surgery