SynthesisNeurocritical care2026
Surgical Interventions for Super-Refractory Status Epilepticus: A Systematic Review.
Synthesis in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSuper-refractory status epilepticus (SRSE) is a neurological emergency defined as status epilepticus persisting for more than 24 h despite conventional management with anesthetics or recurrence with withdrawal of anesthesia. It is associated with high morbidity and mortality, and contemporary literature on treatment is limited. We present a systematic review of surgical interventions and outcomes for SRSE.
methodsWe performed a multidatabase literature search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using an International Prospective Register of Systematic Reviews (PROSPERO)-registered protocol, to identify published literature through February 2024. Four reviewers independently screened citations, abstracts, and manuscripts of SRSE with surgical or neuromodulatory interventions in pediatric and adult populations, with a senior reviewer resolving discrepancies. The primary outcomes were the resolution of SRSE and Engel I classification at the last reported follow-up.
resultsWe screened 1436 citations, reviewed 66 manuscripts, and identified 114 patients who underwent acute neurosurgical intervention for SRSE. Of the 114 cases, 111 had resolution of SRSE after the intervention, and 57 of 114 patients were reported to be Engel class I (free of disabling seizures) at the last follow-up. Among the remaining half (57), 8 patients did not survive, 3 had recurrence of status epilepticus, and 46 continued to have medically refractory seizures, with 29 experiencing fewer seizures than before. Our subgroup analyses also highlighted that surgical interventions were effective even in patients with underlying autoimmune and genetic etiologies. An additional striking finding was that the patients who had surgical interventions delayed beyond 3 weeks from the SRSE onset were less likely to achieve resolution of SRSE and had poorer longitudinal seizure freedom (40.7%), in contrast to earlier intervention groups (70%), favoring early intervention.
conclusionsOur work demonstrates that surgical interventions may be considered for the treatment of SRSE, even in cases with a known genetic and autoimmune etiology, and earlier intervention may lead to better outcomes.
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