Abstracts

Rationale: Super-refractory status epilepticus is defined as status epilepticus that continues for more than 24 hours despite aggressive treatment with anesthetics. There is no established treatment or practical guidelines for super-refractory status epilepticus, and management is variable with additional pharmacologic or non-pharmacologic interventions (such as ketamine, neurosteroids, hypothermia, ketogenic diet, emergent neurosurgery, electroconvulsive therapy, vagal nerve stimulation). Magnetoencephalography (MEG) is being used for pre-surgical evaluation for identification of focal epileptic activity and for pre-surgical mapping of eloquent cortices. We present three patients with super-refractory focal status epilepticus for which MEG was used emergently to delineate epileptic cortex for surgery, with subsequent resolution of status epilepticus. Methods: Two pediatric patients and one adult patient admitted to ICU with status epilepticus refractory to pharmacologic treatment including anesthetics, undergo emergent MEG for better localization of the epileptic zone in preparation for surgical resection of the epileptic focus. MEG data was obtained in concordance with ACMEGS clinical practice guidelines for MEG. The two pediatric patients were intubated and sedated at the time of MEG, while the adult patient was not intubated and on mild sedation. Results: Two of the patients had non-lesional brain MRI and one had focal cortical dysplasia in the area that was generating seizures. MEG data was used for identification of the epileptic cortex. Emergent surgical resection of the areas identified as epileptic resulted in resolution of status epilepticus in all three patients. All patients were seizure free at their first post-surgical follow up. Conclusions: Currently, there are ten evidence-based MEG indications in presurgical evaluation of patients with drug-resistant epilepsy (1). MEG data is usually acquired in outpatient settings after careful preparations prior to the study. We present three instances where MEG was done emergently, in inpatient settings, as an aiding tool for surgical intervention for super-refractory status epilepticus, with favorable outcomes in all three patients. Therefore, emergent MEG in management of patients with super-refractory status epilepticus should be considered as an additional indication for MEG.Reference: 1. Youmans and Winn Neurological Surgery seventh edition, Philadelphia, Elsevier, 2017, chapter 66, pages 433-445. Funding: None