Ng Yu-Tze, Bristol Ruth E, Schrader Dewi V, Smith Kris A
Division of Pediatric Neurology, Barrow Neurological Institute/St. Joseph's Hospital and Medical Center, 500 West Thomas Road Suite 400, Phoenix, AZ 85013, USA.
Neurocrit Care. 2007;7(1):86-91. doi: 10.1007/s12028-007-0038-4.
Status epilepticus remains a life-threatening condition that afflicts both adults and children which although occurs in patients with epilepsy, often presents as new-onset seizure activity also. Refractory status epilepticus poses a management challenge for neurological and neurosurgical teams.
Subdural grid electrodes were used to record cortical discharges and guide tumor resection involving eloquent cortex and multiple subpial transections in a 48-year-old man with left hemiparesis in status epilepticus. He had been refractory to multiple medical therapies in persistent epilepsia partialis continua for a prolonged period. As an alternative to higher-dose suppressive medical therapy, the patient elected to proceed with subdural grid mapping after seizure semiology ("negative" scalp electroencephalogram) localized the seizure focus to the right hemisphere, motor cortex. Following tumor removal, multiple subpial transections were subsequently performed over large areas of the motor and sensory strips and successfully resolved the status epilepticus.
The patient made an excellent recovery, became seizure free, had improved left-sided strength and was discharged home shortly after.
This case illustrates a potentially life-saving technique for the treatment of refractory status epilepticus. Multiple subpial transections and other neurosurgical intervention should be considered for patients with status epilepticus. When localization with surface electrodes is poor, especially in eloquent cortex, subdural grid recording can be used to direct focal resection and/or multiple subpial transections to minimize neurological deficits. A review and summary of previously published neurosurgery cases for status epilepticus is discussed.
癫痫持续状态仍然是一种危及生命的疾病，影响着成人和儿童，虽然它发生在癫痫患者中，但也常常表现为新发的癫痫发作活动。难治性癫痫持续状态给神经科和神经外科团队带来了管理挑战。
在一名癫痫持续状态伴左侧偏瘫的48岁男性患者中，使用硬膜下格栅电极记录皮质放电，并指导涉及明确皮质和多次软膜下横切术的肿瘤切除。他长期处于持续性部分性癫痫持续状态，对多种药物治疗均无效。作为高剂量抑制性药物治疗的替代方案，在癫痫发作症状学（头皮脑电图“阴性”）将癫痫病灶定位于右侧半球运动皮质后，患者选择进行硬膜下格栅定位。肿瘤切除后，随后在运动和感觉区的大片区域进行了多次软膜下横切术，并成功解决了癫痫持续状态。
患者恢复良好，癫痫发作停止，左侧肌力改善，不久后出院回家。
本病例说明了一种治疗难治性癫痫持续状态的潜在挽救生命的技术。对于癫痫持续状态患者，应考虑多次软膜下横切术和其他神经外科干预措施。当表面电极定位不佳时，尤其是在明确的皮质区域，硬膜下格栅记录可用于指导局灶性切除和/或多次软膜下横切术，以尽量减少神经功能缺损。本文还讨论了先前发表的癫痫持续状态神经外科病例的综述和总结。
