Epilepsy surgery in pediatric refractory status epilepticus

The mainstay of status epilepticus (SE) treatment is pharmacotherapy with anti-seizure medications (ASM). In refractory status epilepticus (RSE), when additional ASM are not effective, high-dose suppressive therapy with either benzodiazepines, thiopental, phenobarbitone, or propofol is used to suppress clinical and EEG seizure activity. However, in selected eligible cases of RSE or in super-refractory cases, epilepsy surgery may be the treatment of choice to terminate SE. Here, we review epilepsy surgery including deep brain stimulation (DBS) for treatment for RSE with emphasis on special aspects of presurgical evaluation, patient selection, and outcome. We focus on surgical treatment options for patients in the acute phase of RSE, who have received high-dose suppressive therapy prior to surgery in the majority of the cases.