Treatment of refractory partial status epilepticus with multiple subpial transection: case report

Status epilepticus (SE) represents a medical emergency that annually affect s 60 000-150 000 individuals in the United States. Selective neuronal loss in vulnerable areas has been pathologically demonstrated following convulsi ve SE primarily affecting the limbic system, thalamus and cerebellum. Morbidity in those cases that follow refractory SE (RSE) is poorly document ed. There have been anecdotal reports of surgical treatment for this condit ion, especially secondary to brain lesions. We report a 6-year-old patient who was in RSE for 60 days, without a brain lesion documented by MRI. The patient underwent multiple subpial transection (MST) of the sensorimoto r cortex, which by ictal EEG and ictal SPECT proved to be the epileptogenic zone. We conclude that MST should be considered as an alternative treatment for r efractory partial SE. (C) 2001 BEA Trading Ltd.