Seminars in pediatric neurology
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Semin Pediatr Neurol · Sep 2010
ReviewSurgical treatment of refractory status epilepticus in children: candidate selection and outcome.
Surgical treatment emerges as a therapeutic option for refractory status epilepticus (RSE) in children. Surgical approaches for RSE include focal cortical resections, hemispherectomies, multiple subpial transections, and rarely corpus callosotomy and vagal nerve stimulator implantation. Resective surgery has shown immediate- and long-term benefits in cases of definite localization of the epileptogenic focus by elecrographic and imaging data. ⋯ The optimal timing of surgery in eligible patients has been determined by concerns about medical intractability weighed against accumulating risks of RSE and the possible appearance of secondary epileptogenic zones caused by ongoing seizures. Overall, preliminary case series suggest that epilepsy surgery may be an alternative treatment option for selected children with RSE. Additional studies are needed to delineate timing and criteria for intervention as well as prognostic factors.
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Status epilepticus (SE) is a common pediatric neurologic emergency that refers to a prolonged seizure or recurrent seizures without a return to baseline mental status between seizures. Appropriate treatment strategies are necessary to prevent prolonged SE and its associated morbidity and mortality. This review discusses the importance of a rapid and organized management approach, reviews data related to commonly utilized medications including benzodiazepines, phenytoin, phenobarbital, valproate sodium, and levetiracetam, and then provides a sample SE management algorithm.
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Semin Pediatr Neurol · Sep 2010
ReviewStatus epilepticus treatment and outcome in children: what might the future hold?
Status epilepticus is a life-threatening emergency that requires urgent treatment. Over the past decade, numerous advances have been made in the management of status epilepticus. ⋯ Neuroscientific advances are revealing mechanisms of status epilepticus that could translate into targets for treating acute status epilepticus and even reducing epileptogenesis. This article discusses future trends in the diagnosis, neurobiology, and treatment of status epilepticus.