College of Medicine, The University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA.
Department of Neurosurgery, University of Louisville Restorative Neuroscience, Louisville, Kentucky, USA.
World Neurosurg. 2022 Nov;167:195-204.e7. doi: 10.1016/j.wneu.2022.07.141. Epub 2022 Aug 7.
Super-refractory status epilepticus (SRSE) is a neurologic emergency with high mortality and morbidity. Although medical algorithms typically are effective, when they do fail, options may be limited, and neurosurgical intervention should be considered.
We report a case of SRSE treated acutely with responsive neurostimulation (RNS) and focal surgical resection after intracranial monitoring. We also conducted a systematic review of the literature for neurosurgical treatment of SRSE (e.g., neurostimulation). Only published manuscripts were considered.
Our patient's seizure semiology consisted of left facial twitching with frequent evolution to bilateral tonic-clonic convulsions. Stereoelectroencephalography and grid monitoring identified multiple seizure foci. The patient underwent right RNS placement with cortical strip leads over the lateral primary motor and premotor cortex as well as simultaneous right superior temporal and frontopolar resection. Status epilepticus resolved 21 days after surgical resection and placement of the RNS. The systematic review revealed 15 case reports describing 17 patients with SRSE who underwent acute neurosurgical intervention. There were 3 patients with SRSE with RNS placement as a single modality, all of whom experienced cessation of SE. Four patients with SRSE received vagus nerve stimulation (3 as a single modality and 1 with combined corpus callosotomy), of whom 1 had SE recurrence at 2weeks. Two patients with SRSE received deep brain stimulation, and the remaining 8 underwent surgical resection; none had recurrence of SE.
RNS System placement with or without resection can be a viable treatment option for select patients with SRSE. Early neurosurgical intervention may improve seizure outcomes and reduce complications.
难治性癫痫持续状态（SRSE）是一种具有高死亡率和发病率的神经急症。尽管通常采用医学算法治疗，但当这些方法失败时，选择可能有限，应考虑神经外科干预。
我们报告了一例 SRSE 患者，在颅内监测后，通过响应性神经刺激（RNS）和局灶性手术切除进行急性治疗。我们还对神经外科治疗 SRSE（例如神经刺激）的文献进行了系统回顾。仅考虑已发表的手稿。
我们患者的癫痫发作表现为左侧面部抽搐，常演变为双侧强直阵挛性抽搐。立体脑电图和网格监测确定了多个癫痫灶。患者接受了右侧 RNS 放置，在外侧初级运动和运动前皮质上放置皮质条带电极，同时进行右侧上部颞叶和额极切除术。手术切除和 RNS 放置后 21 天，癫痫持续状态得到缓解。系统回顾显示，有 15 例病例报告描述了 17 例 SRSE 患者接受了急性神经外科干预。有 3 例 SRSE 患者单独采用 RNS 治疗，所有患者均停止了 SE。4 例 SRSE 患者接受了迷走神经刺激（3 例为单一模式，1 例联合胼胝体切开术），其中 1 例在 2 周时出现 SE 复发。2 例 SRSE 患者接受了深部脑刺激，其余 8 例患者接受了手术切除；无一例 SE 复发。
对于选择的 SRSE 患者，RNS 系统放置（或不切除）可以是一种可行的治疗选择。早期神经外科干预可能改善癫痫发作结局并减少并发症。
