Neuromodulation for Management for Super Refractory Status Epilepticus: A Systemic Review
Abstract number :
1.348
Submission category :
9. Surgery / 9C. All Ages
Year :
2022
Submission ID :
2204865
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:26 AM
Authors :
Yajing Xiong, MD – University of Pittsburgh Medical Center; Mohamed Elrefaey, MD – Resident Physician, SUNY Upstate Medical University; Emily In, BS – University of Pittsburgh School of Medicine; Derrick Barnagian, BS – University of Pittsburgh School of Medicine; James Castellano, MD, PhD – Neurology – University of Pittsburgh Medical Center; Jorge Gonzalez-Martinez, MD, PhD – Neurosurgery – University of Pittsburgh Medical Center; Anto Bagic, MD, PhD – Neurology – University of Pittsburgh School of Medicine; Niravkumar Barot, MD, MPH – Assistant Professor, Department of Neurology, University of Pittsburgh Medical Center
Rationale: Super refractory status epilepticus (SRSE) is a neurological emergency defined as status epilepticus persisting more than 24 hours despite aggressive management with IV anesthesia. It requires prompt management as it carries high mortality and morbidity. Implantable neurostimulation therapies are valuable option for those not candidate for resective surgeries. The objective of this study was to conduct a systematic review of neuromodulation therapies in their treatment of SRSE and assessing clinical outcomes.
Methods: We performed a literature search of Medline, PubMed, Embase, Cochrane, Clinicaltrials.gov, to include all existing published literature until August 2021. This is review was conducted according to PRISMA guidelines and protocol was registered with the international Prospective Register of Systematic Review. Four reviewers screened citations, abstracts, and manuscripts independently with a senior reviewer resolving any discrepancies. We included case reports and case series detailing cases of SRSE in adult and pediatric populations and their outcome after neuromodulation therapies was applied. Extracted data including demographics of the patients, types of epilepsy, EEG results, lesions related to epilepsy, types of intervention, outcomes after intervention. Our primary outcome was the mean percentage was resolution of status epilepticus and out secondary outcome included proportion of those who achieved permanent seizure freedom.
Results: Our systematic review included 27 individuals who fulfilled the study criteria and underwent urgent implantation of VNS (n=17), DBS (n=7), or RNS (n=3) as management of their SRSE. Mean age (years) was 25.9 (range, 1.1-67) with median of 24.5. Identifiable etiology to the SRSE was present in 2/3 of the cases, out of which genetic condition (n=5) was the most common. 25.9% (n=7) of the cases had lesion(s) present on MRI. The average number ASM use prior to implantation was 6.4 (SD=2.7) and average number of IV anesthetic drugs used was 2.5 (SD=1.1). Our data determined that for the primary outcome, 92% (n=26) of the cases had resolution in their status epilepticus. Not all of cases had details on when SE resolved after implantation, however out of the studies listed (n=18), the average day to SE resolution was 4.5 (SD=3.4) and median of 4. The secondary outcome suggests that 25% of cases had sustained seizure freedom at the last follow up with mean follow up duration of 16 months.
Conclusions: These data demonstrates that neuromodulation should be considered as possible curative therapy in patients with SRSE.
Funding: None
Surgery