gms | German Medical Science

Objective: Status epilepticus (SE) is a potentially life-threatening condition. However, in most of the cases pharmacological therapy is sufficient. But sometimes even deep anesthesia on the intensive care unit is needed to terminate seizures. For a few patients even this will not help to end this vicious cycle. In these selected cases, epilepsy surgery may be of benefit as an emergency procedure for SE if a seizure focus or epileptogenic zone has been detected in presurgical evaluation. Nevertheless, data in the literature regarding these rare cases are lacking.

Method: We retrospectively reviewed our own epilepsy surgery database for emergency procedures due to SE and and reviewed the literature.

Results: One hundred and seventy-nine patients were operated on at our epilepsy surgery unit between June 2011 and October 2014. Two patients had to be classified as emergencies due to medically refractory SE. The first patient has already suffered from focal epilepsy for 2 years after traumatic brain injury with temporal contusions. He then went into an SE that could not be controlled pharmacologically and EEG evaluation revealed a seizure focus on the right side, fitting to the initial trauma. Morphologically, a hippocampal sclerosis was apparent, so that an anteromesial temporal resection was performed, which led to a termination of the SE.

The second patient was referred to our center with a dyscognitive SE that had been refractory for two weeks. A cavernoma in the right occipital lobe next to the splenium had been primarily irradiated in the referring center, causing an extensive brain edema. Further EEG analysis showed a seizure initiation fitting to the MRI findings. Hence, extended lesionectomy was indicated as emergency procedure. However, termination of SE could not be reached.

Conclusions: Epilepsy surgery procedures are usually well-planned elective operations. In selected cases of medically refractory SE, epilepsy surgery can be indicated as emergency procedure when all options of non-invasive treatments have been exhausted.