Abstracts

Refractory status epilepticus (RSE) is a life-threatening emergency that requires prompt treatment. Mortality in children with RSE ranges from 16% to 43.5%. Surgical treatments have been proposed as an alternative to medical therapy for RSE in patients with pre-existing epilepsy. However, defining the epileptogenic zone is often challenging in the presence of widespread neuronal irritation during RSE. Magnetoencephalography (MEG) uses an equivalent current dipole model overlaid onto MR images to localize sources of interictal and infrequently ictal epileptiform discharges. We report the surgical outcome of four children with RSE and the role of MEG in planning the surgical treatment for RSE., We studied four children (age: 2.5-10 years) who presented with RSE. All patients failed initial standard protocol of high-dose suppressive therapy utilizing intravenous midazolam drip. High-dose phenobarbital tailored to suppression-burst was used in one patient. All patients underwent scalp video EEG monitoring and MRI. Ictal MEG was performed under midazolam drip in two patients. Three patients had pre-existing epilepsy. Etiology was cortical malformations (2), presumed viral encephalitis (1) and Rasmussen[apos]s encephalitis (1)., Ictal EEG onset were localized in two patients and lateralized in the other two. Ictal MEG data were obtained in two patients. Ictal dipole localizations were regionally concordant with ictal onset zones on scalp video EEG in two patients. Interictal MEG revealed unilateral clustered dipoles (3) and bilateral clusters (1). We performed cortical resections (2), functional hemispherectomy (1) and anterior temporal lobectomy (1). RSE stopped in all four patients. Two patients are seizure free at 3 years, 6 months follow up each. The other two have infrequent seizures. Functional deficits included; dense hemiparesis (1), transient hemiparesis (2) and cognitive decline (1)., Surgical treatments should be considered in children with RSE. MEG provides information of the epileptogenic zone for RSE. Ictal and interictal MEG data during RSE can guide surgical resection to stop status epilepticus and avoid iatrogenic side effects associated with high-dose suppressive therapy.,