Albalawi Rawan, Aljthalin Raseel, Khan Sonia, Fouly Raghad, Alshahrani Mohammed, Alsahli Hamoud, Alhashemi Moustafa
Department of Adult Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Faculty of Medicine, University of Aleppo, Aleppo, Syria.
Ann Med Surg (Lond). 2024 Aug 22;86(10):6215-6220. doi: 10.1097/MS9.0000000000002501. eCollection 2024 Oct.
Super-refractory status epilepticus is defined as status epilepticus that continues or recurs 24 h or more after the initiation of anesthetic therapy(continuum), a serious medical emergency with a potential for significant morbidity and mortality. Cortisectomy with invasive EEG recording electrocorticography (ECoG) can be a successful treatment option for super-refractory status epilepticus in selected cases after medical management has failed.
The authors present a case of a young lady who suffered a super-refractory status epilepticus and failed five different anti-seizure medications, coma-producing agents, IVIG. After failure of multiple medical and sedative therapy cortisectomy was done with the use of invasive EEG recording electrocorticography (ECoG) to tailor and localize the epileptogenic zone.
When dealing with status epilepticus (SE) that is refractory to treatment, early surgical intervention should be taken into consideration as a viable option. Although there are only a few published cases of SE treated with epilepsy surgery, these cases have shown positive outcomes. In fact, one study demonstrated a significant improvement in seizure control for patients with SE who underwent surgical treatment using these techniques.
Cortisectomy, which is a rare and invasive procedure, could be considered as a potential treatment for patients who have not responded to multiple medical and sedative therapies.
超难治性癫痫持续状态被定义为在麻醉治疗开始后持续或复发24小时及以上的癫痫持续状态（连续体），这是一种严重的医疗急症，具有显著的发病和死亡风险。对于经药物治疗失败的特定病例，采用侵入性脑电图记录皮层脑电图（ECoG）的皮质切除术可能是治疗超难治性癫痫持续状态的成功选择。
作者介绍了一位年轻女性的病例，她患有超难治性癫痫持续状态，使用了五种不同的抗癫痫药物、致昏迷药物和静脉注射免疫球蛋白均治疗失败。在多种药物和镇静治疗均失败后，通过使用侵入性脑电图记录皮层脑电图（ECoG）进行皮质切除术，以确定癫痫发作起始区并进行定位。
在处理难治性癫痫持续状态（SE）时，应考虑早期手术干预作为一种可行的选择。虽然仅有少数关于癫痫手术治疗SE的病例报道，但这些病例均显示出了积极的治疗效果。事实上，一项研究表明，采用这些技术进行手术治疗的SE患者在癫痫控制方面有显著改善。
皮质切除术是一种罕见且具有侵入性的手术，对于多种药物和镇静治疗均无反应的患者可考虑作为一种潜在的治疗方法。
