Comparison of three types of Epilepsy Surgery for the treatment of Refractory Status Epilepticus: A Single Center Experience (P9-1.005)

Abstract

<h3>Objective:</h3> Comparing outcomes for three categories of epilepsy surgery in Refractory Status Epilepticus Patients (RSE). <h3>Background:</h3> Literature comparing morbidity and mortality outcomes between three types of epilepsy surgery for RSE patients is scarce. Previous case series have focused on one type of surgery or does not directly compare outcomes between the modalities. <h3>Design/Methods:</h3> A retrospective analysis for RSE between 2010 and 2021 was done. Sociodemographic data, semiology and etiology were collected. The patients were deidentified using our institute’s software, and comparison data was extracted from the secure system. Data collected included lag time between diagnosis and surgery, number of anti-seizure medications (ASMs) tried, EEG and imaging data, type of surgery performed, level of post-operative care, number of post-operative days admitted, complications and seizure freedom outcomes. <h3>Results:</h3> The mean age was 35.6 ± 23.5 years, with 4/12 patients being female. Seizure types were primarily generalized tonic-clonic or focal seizures with impaired awareness. A plethora of etiologies were included. The mean number of ASMs tried was 2.3 ± 1.4. Every patient had EEG and MRI Brain with ancillary testing such as grid placement. Out of 12, 6 had resection, 5 disconnections and 2 neuromodulations. 11/12 patients required an ICU admission and mean post-operative days admitted was 12 ± 11.2. Minor to no complications occurred in 33 % of all resection patients, and minor complications occurred in 40 % and 50 % patients of the disconnection and modulation patients. 3/4 and 3/5 of patients that had undergone resections and disconnections respectively had Class 1 outcomes in. Patients that received modulation had a Class 4 outcome and 1 patient death. <h3>Conclusions:</h3> Our study reveals that while there is no substantial difference between resection and disconnection, resections have slightly better outcomes and fewer complications. Modulation had poorer seizure freedom and may only be considered as a temporizing measure. <b>Disclosure:</b> Dr. Khan has received personal compensation for serving as an employee of University of Kentucky. Dr. Mirza has nothing to disclose. Dr. Mathias has received research support from My Epilepsy Society Non Profit Organization.