Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Epilepsia Open. 2024 Jun;9(3):850-864. doi: 10.1002/epi4.12924. Epub 2024 Mar 8.
Status Epilepticus (SE), unresponsive to medical management, is associated with high morbidity and mortality. Surgical management is typically considered in these refractory cases. The best surgical approach for affected patients remains unclear; however, given the lack of controlled trials exploring the role of surgery. We performed a systematic review according to PRIMSA guidelines, including case reports and series describing surgical interventions for patients in SE. Cases (157 patients, median age 12.9 years) were followed for a median of 12 months. Patients were in SE for a median of 21 days before undergoing procedures including: focal resection (36.9%), functional hemispherectomy (21%), lobar resection (12.7%), vagus nerve stimulation (VNS) (12.7%), deep brain stimulation (DBS) (6.4%), multiple subpial transection (MST) (3.8%), responsive neurostimulation (RNS) (1.9%), and cortical stimulator placement (1.27%), with 24 patients undergoing multiple procedures. Multiple SE semiologies were identified. 47.8% of patients had focal seizures, and 65% of patients had focal structural abnormalities on MRI. SE persisted for 36.8 ± 47.7 days prior to surgical intervention. SE terminated following surgery in 81.5%, terminated with additional adjuncts in 10.2%, continued in 1.9%, and was not specified in 6.4% of patients. Long-term seizure outcomes were favorable, with the majority improved and 51% seizure-free. Eight patients passed away in follow-up, of which three were in SE. Seizures emerging from one hemisphere were both more likely to immediately terminate (OR 4.7) and lead to long-term seizure-free status (OR 3.9) compared to nonunilateral seizures. No other predictors, including seizure focality, SE duration, or choice of surgical procedure, were predictors of SE termination. Surgical treatment of SE can be effective in terminating SE and leading to sustained seizure freedom, with many different procedures showing efficacy if matched appropriately with SE semiology and etiology. PLAIN LANGUAGE SUMMARY: Patients with persistent seizures (Status Epilepticus) that do not stop following medications can be treated effectively with surgery. Here, we systematically review the entirety of existing literature on surgery for treating status epilepticus to better identify how and when surgery is used and what patients do after surgery.
癫痫持续状态（SE），即对药物治疗无反应，与高发病率和死亡率相关。在这些难治性病例中，通常会考虑手术治疗。对于受影响的患者，最佳手术方法仍不清楚；然而，由于缺乏探索手术作用的对照试验。我们根据 PRIMSA 指南进行了系统评价，包括描述 SE 患者手术干预的病例报告和系列。病例（157 名患者，中位年龄 12.9 岁）中位随访 12 个月。患者在接受手术前中位 SE 持续时间为 21 天，包括：局灶性切除术（36.9%）、功能性半脑切除术（21%）、叶切除术（12.7%）、迷走神经刺激术（VNS）（12.7%）、深部脑刺激术（DBS）（6.4%）、多发性软膜下横断术（MST）（3.8%）、反应性神经刺激术（RNS）（1.9%）和皮质刺激器放置（1.27%），24 名患者接受了多种手术。确定了多种 SE 半表型。47.8%的患者有局灶性发作，65%的患者 MRI 上有局灶性结构异常。在手术干预前，SE 持续了 36.8±47.7 天。81.5%的患者在手术后 SE 终止，10.2%的患者在手术后需要额外的辅助治疗，1.9%的患者 SE 持续，6.4%的患者未明确说明。长期癫痫发作结果良好，大多数患者改善，51%无癫痫发作。8 名患者在随访中死亡，其中 3 名处于 SE 状态。与非单侧发作相比，来自一侧的发作更有可能立即终止（OR 4.7）并导致长期无癫痫发作状态（OR 3.9）。没有其他预测因素，包括发作局灶性、SE 持续时间或手术方式的选择，是 SE 终止的预测因素。SE 的手术治疗可以有效地终止 SE 并导致持续的癫痫无发作，许多不同的手术方法如果与 SE 半表型和病因相匹配，都可以显示出疗效。
