SURGICAL TREATMENT FOR ACUTE SYMPTOMATIC REFRACTORY STATUS EPILEPTICUS USING MAGNETOENCEPHALOGRAPHY
Bibliographic record
Abstract
Objectives: Refractory status epilepticus (RSE) is a life-threatening emergency that requires high-dose suppressive therapy (HDST) and is associated with significant mortality and morbidity. We describe the first report of resective surgery to treat acute symptomatic RSE in children. Methods: A previously healthy 10 year old, right –handed boy presented with generalized convulsive status epilepticus. Seven days prior to presentation, he developed a mild febrile illness for two days. Lumbar puncture showed normal glucose and protein, 2 WBCs and 1 RBC. Metabolic and infectious screens were negative. We studied pronged video–scalp EEG (VEEG) monitoring, repeated MRI including diffusion- weighted images, and magnetoencephalography (MEG). Results: MRI on day 1 was normal. VEEG revealed frequent right hemispheric seizures preceded by right temporal sharp waves. Midazolam drip, high dose topiramate and repeated phenobarbital boluses inducing a suppression -burst pattern did not control seizures. Repeat MR images on day 6 revealed restricted diffusion in the right hippocampus. MEG showed clustered anterior vertical or horizontal temporal dipoles indicative of the right mesial temporal discharges at the ictal onset of EEG seizures in addition to interictally. The patient underwent right anterior temporal lobectomy on day 9. Postoperatively, he gradually regained consciousness over 2 weeks. At 6 months follow up, neuropsychologic assessment revealed cognitive functions one grade level below his age. He attends regular school and has infrequent nocturnal seizures controlled by antiepileptic drugs. Conclusion: Ictal and interictal MEG study can reveal the epileptogenic zone in selected patients during status epilepticus. In such case, epilepsy surgery should be considered after failure of HDST.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".