Successful treatment of super-refractory focal status epilepticus: Surgery, vagus nerve stimulation, and botox for epilepsia partialis continua
Super-refractory status epilepticus (SRSE) is a life-threatening condition characterized by persistent seizures lasting beyond seven days despite anesthetic therapy. Managing SRSE is challenging, particularly in cases resistant to conventional treatments. This case report presents a 41-year-old fema...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-09-01
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| Series: | Epilepsy & Behavior Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589986425000358 |
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| author | N. Zalmay G. Nune C.N. Heck K.T. Dao B.T. Ly J. Ipe C.Y. Liu H.P. Kunhi Veedu |
| author_facet | N. Zalmay G. Nune C.N. Heck K.T. Dao B.T. Ly J. Ipe C.Y. Liu H.P. Kunhi Veedu |
| author_sort | N. Zalmay |
| collection | DOAJ |
| description | Super-refractory status epilepticus (SRSE) is a life-threatening condition characterized by persistent seizures lasting beyond seven days despite anesthetic therapy. Managing SRSE is challenging, particularly in cases resistant to conventional treatments. This case report presents a 41-year-old female with prolonged SRSE secondary to focal epilepsy, successfully treated with surgical resection, vagus nerve stimulation (VNS), and botulinum toxin (BoNT) therapy. The patient initially presented with left focal motor status epilepticus and a right frontal intracerebral hematoma. Despite an emergency craniotomy, her seizures persisted, leading to prolonged SRSE. After multiple failed sedation weaning attempts, a stepwise intervention approach was implemented consisting of an Electrocorticography (ECoG)-guided surgical resection of the residual epileptic focus, VNS implantation for long-term seizure modulation, BoNT therapy for residual epilepsia partialis continua (EPC). The combined approach of surgical resection and VNS implantation successfully terminated the status epilepticus. Residual Epilepsia Partialis Continua (EPC) was effectively managed with botulinum toxin therapy (BoNT). This case underscores the potential efficacy of combining surgical resection and VNS implantation in treating SRSE and highlights the beneficial effects of BoNT in managing residual EPC, offering a potential treatment pathway for similar refractory cases. |
| format | Article |
| id | doaj-art-10bc38a2f3554f1aa087812fb2db84c7 |
| institution | OA Journals |
| issn | 2589-9864 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Epilepsy & Behavior Reports |
| spelling | doaj-art-10bc38a2f3554f1aa087812fb2db84c72025-08-20T01:49:08ZengElsevierEpilepsy & Behavior Reports2589-98642025-09-013110077510.1016/j.ebr.2025.100775Successful treatment of super-refractory focal status epilepticus: Surgery, vagus nerve stimulation, and botox for epilepsia partialis continuaN. Zalmay0G. Nune1C.N. Heck2K.T. Dao3B.T. Ly4J. Ipe5C.Y. Liu6H.P. Kunhi Veedu7Kern Medical Center, United States; Corresponding author.University of Southern California, United StatesUniversity of Southern California, United StatesKern Medical Center, United StatesKern Medical Center, United StatesKern Medical Center, United StatesUniversity of Southern California, United StatesKern Medical Center, United StatesSuper-refractory status epilepticus (SRSE) is a life-threatening condition characterized by persistent seizures lasting beyond seven days despite anesthetic therapy. Managing SRSE is challenging, particularly in cases resistant to conventional treatments. This case report presents a 41-year-old female with prolonged SRSE secondary to focal epilepsy, successfully treated with surgical resection, vagus nerve stimulation (VNS), and botulinum toxin (BoNT) therapy. The patient initially presented with left focal motor status epilepticus and a right frontal intracerebral hematoma. Despite an emergency craniotomy, her seizures persisted, leading to prolonged SRSE. After multiple failed sedation weaning attempts, a stepwise intervention approach was implemented consisting of an Electrocorticography (ECoG)-guided surgical resection of the residual epileptic focus, VNS implantation for long-term seizure modulation, BoNT therapy for residual epilepsia partialis continua (EPC). The combined approach of surgical resection and VNS implantation successfully terminated the status epilepticus. Residual Epilepsia Partialis Continua (EPC) was effectively managed with botulinum toxin therapy (BoNT). This case underscores the potential efficacy of combining surgical resection and VNS implantation in treating SRSE and highlights the beneficial effects of BoNT in managing residual EPC, offering a potential treatment pathway for similar refractory cases.http://www.sciencedirect.com/science/article/pii/S2589986425000358Super-refractory status epilepticusSurgical resectionVagus nerve stimulationBotulinum toxin therapyTraumatic brain injuryCase report |
| spellingShingle | N. Zalmay G. Nune C.N. Heck K.T. Dao B.T. Ly J. Ipe C.Y. Liu H.P. Kunhi Veedu Successful treatment of super-refractory focal status epilepticus: Surgery, vagus nerve stimulation, and botox for epilepsia partialis continua Epilepsy & Behavior Reports Super-refractory status epilepticus Surgical resection Vagus nerve stimulation Botulinum toxin therapy Traumatic brain injury Case report |
| title | Successful treatment of super-refractory focal status epilepticus: Surgery, vagus nerve stimulation, and botox for epilepsia partialis continua |
| title_full | Successful treatment of super-refractory focal status epilepticus: Surgery, vagus nerve stimulation, and botox for epilepsia partialis continua |
| title_fullStr | Successful treatment of super-refractory focal status epilepticus: Surgery, vagus nerve stimulation, and botox for epilepsia partialis continua |
| title_full_unstemmed | Successful treatment of super-refractory focal status epilepticus: Surgery, vagus nerve stimulation, and botox for epilepsia partialis continua |
| title_short | Successful treatment of super-refractory focal status epilepticus: Surgery, vagus nerve stimulation, and botox for epilepsia partialis continua |
| title_sort | successful treatment of super refractory focal status epilepticus surgery vagus nerve stimulation and botox for epilepsia partialis continua |
| topic | Super-refractory status epilepticus Surgical resection Vagus nerve stimulation Botulinum toxin therapy Traumatic brain injury Case report |
| url | http://www.sciencedirect.com/science/article/pii/S2589986425000358 |
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