Management of non-lesional super refractory status epilepticus: a rare case report

Abstract

Introduction and importance: Super-refractory status epilepticus is defined as status epilepticus that continues or recurs 24 hours 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. Case presentation: we 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. Clinical discussion: 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. Conclusion: 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.