Division of Epilepsy, Department of Neurology, Wayne State University School of Medicine, 4201 St Antoine, 8C UHC, Detroit, MI, 48201, USA.
Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA.
Neurocrit Care. 2017 Dec;27(3):370-380. doi: 10.1007/s12028-017-0381-z.
To identify the role of acute surgical intervention in the treatment of refractory status epilepticus (RSE).
Retrospective review of consecutive patients who underwent epilepsy surgery from 2006 to 2015 was done to identify cases where acute surgical intervention was employed for the treatment of RSE. In addition, the adult and pediatric RSE literature was reviewed for reports of surgical treatment of RSE.
Nine patients, aged 20-68 years, with various etiologies were identified to have undergone acute surgical resection for the treatment of RSE, aided by electrocorticography. Patients required aggressive medical therapy with antiepileptic drugs and intravenous anesthetic drugs for 10-54 days and underwent extensive neurodiagnostic testing prior to resective surgery. Eight out of nine patients survived and five patients were seizure-free at the last follow-up. The literature revealed 13 adult and 48 pediatric cases where adequate historical detail was available for review and comparison.
We present the largest cohort of consecutive adult patients who underwent resective surgery in the setting of RSE. We also reveal that surgery can be efficacious in aborting status and in some can lead to long-term seizure freedom. Acute surgical intervention is a viable option in prolonged RSE and proper evaluation for such intervention should be conducted, although the timing and type of surgical intervention remain poorly defined.
明确急性外科干预在难治性癫痫持续状态（RSE）治疗中的作用。
回顾性分析 2006 年至 2015 年连续接受癫痫手术的患者，以确定采用急性外科干预治疗 RSE 的病例。此外，还回顾了成人和儿科 RSE 文献中关于手术治疗 RSE 的报告。
共确定了 9 例年龄在 20-68 岁之间、病因各异的患者，他们接受了急性外科切除术治疗 RSE，并辅以皮质电图。这些患者需要进行积极的药物治疗，包括抗癫痫药物和静脉麻醉药物，治疗时间为 10-54 天，并在进行切除术之前进行了广泛的神经诊断测试。9 例患者中有 8 例存活，最后一次随访时 5 例无癫痫发作。文献中还报道了 13 例成人和 48 例儿科病例，这些病例有足够的详细病史可供回顾和比较。
我们报告了最大的一组连续接受 RSE 背景下切除术的成年患者。我们还发现，手术可以有效地终止癫痫持续状态，并且在某些情况下可以导致长期无癫痫发作。急性外科干预是延长 RSE 的一种可行选择，应该对这种干预进行适当的评估，尽管手术的时机和类型仍未明确。
