<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0120-8748</journal-id>
<journal-title><![CDATA[Acta Neurológica Colombiana]]></journal-title>
<abbrev-journal-title><![CDATA[Acta Neurol Colomb.]]></abbrev-journal-title>
<issn>0120-8748</issn>
<publisher>
<publisher-name><![CDATA[Asociación Colombiana de Neurología]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0120-87482024000200008</article-id>
<article-id pub-id-type="doi">10.22379/anc.v40i2.1722</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Manejo quirúrgico en el estado epiléptico superrefractario]]></article-title>
<article-title xml:lang="en"><![CDATA[Surgical management in Super-refractory epilepticus status]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Freire Carlier]]></surname>
<given-names><![CDATA[Ivan Dario]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rengifo]]></surname>
<given-names><![CDATA[Laura Juliana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mora Mora]]></surname>
<given-names><![CDATA[Luis Alexander]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Freire Figueroa]]></surname>
<given-names><![CDATA[Iván Andrés]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cifuentes Rincón]]></surname>
<given-names><![CDATA[Angélica Belén]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Internacional de Colombia  ]]></institution>
<addr-line><![CDATA[Piedecuesta ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2024</year>
</pub-date>
<volume>40</volume>
<numero>2</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S0120-87482024000200008&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S0120-87482024000200008&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S0120-87482024000200008&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción: El estado epiléptico refractario (EER) constituye una emergencia médica grave, donde la crisis no cede a pesar del tratamiento farmacológico convencional. Se describe como estado epiléptico superrefractario (EESR) la continua presencia de episodios con una duración de 24 horas o más. Este reporte de caso detalla la complejidad en el manejo y explora un enfoque multidisciplinario.  Presentación del caso: Paciente masculino de 32 años con antecedente de epilepsia focal secundaria a traumatismo craneoencefálico en la niñez, quien ingresó en contexto de EESR, el cual recibió coma barbitúrico, plasmaféresis y dieta cetogénica. En los exámenes, la resonancia magnética reveló una lesión en la región frontotemporal insular derecha; en la tomografía por emisión de positrones se observaron zonas de hipermetabolismo y en el videoelectroencefalograma una continua actividad epileptiforme. Se optó por la cirugía paliativa, logrando la resolución exitosa del EESR y una clasificación Engels IA a los 14 meses.  Discusión: El EESR es un evento neurológico crítico con pronóstico reservado y opciones terapéuticas desafiantes. Se describen opciones terapéuticas desde anticonvulsivantes, inmunoterapia y cirugía, donde el abordaje quirúrgico emerge como una opción eficaz, especialmente en casos con lesiones estructurales. La identificación temprana y la terapia adecuada son vitales para prevenir complicaciones.  Conclusiones: El EESR representa un desafío crítico con alta carga de morbimortalidad, sin embargo, la cirugía de epilepsia muestra promisorios resultados en el contexto de causa cerebral estructural, responsable de la actividad epileptiforme. Se destaca la importancia de la identificación temprana y el manejo quirúrgico paliativo como opción viable, mejorando la calidad de vida de los pacientes.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: Refractory Status Epilepticus (RSE) is a serious medical emergency where the seizure does not subside despite conventional pharmacological treatment. The continuous presence of episodes lasting 24 hours or more is described as super-refractory status epilepticus (SRSE). This case report details the complex in teraphy management and explores a multidisciplinary approach.  Case presentation: A 32-year-old male with a history of focal epilepsy secondary to head trauma in childhood. Enters emergency with a RSE episode. Barbiturate coma, plasmapheresis and ketogenic diet were administered. The Magnetic Resonance Imaging revealed a lesion in the right fronto-temporo-insular cortex, areas of hypermetabolism on Positron Emission Tomography and continuous epileptiform activity on video-electroencephalogram. Palliative surgery was chosen, achieving successful resolution of the SRSE and Engel Scale IA classification at 14 months of follow up.  Discussion: The SRSE is a critical neurological event with a guarded prognosis and complex therapeutic options. Therapeutic options are described from anticonvulsants, immunotherapy and surgery. The surgical approach emerges as an effective option, especially in cases with structural injuries. Early identification and appropriate therapy are vital to prevent complications.  Conclusions: SRSE represents a critical challenge with a high burden of morbidity and mortality. However, epilepsy surgery shows promising results in the context of the structural brain cause responsible for epileptiform activity. The importance of early identification and palliative surgical management as a viable option is highlighted, improving the quality of life of patients.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Epilepsia]]></kwd>
<kwd lng="es"><![CDATA[epilepsia focal]]></kwd>
<kwd lng="es"><![CDATA[estado epiléptico]]></kwd>
<kwd lng="es"><![CDATA[epilepsia refractaria]]></kwd>
<kwd lng="es"><![CDATA[terapias alternativas]]></kwd>
<kwd lng="es"><![CDATA[anestésicos generales]]></kwd>
<kwd lng="es"><![CDATA[anticonvulsivantes]]></kwd>
<kwd lng="es"><![CDATA[dieta cetogénica]]></kwd>
<kwd lng="es"><![CDATA[inmunoterapia]]></kwd>
<kwd lng="es"><![CDATA[estimulación del nervio vago]]></kwd>
<kwd lng="es"><![CDATA[neurocirugía]]></kwd>
<kwd lng="en"><![CDATA[Epilepsy]]></kwd>
<kwd lng="en"><![CDATA[Focal epilepsy]]></kwd>
<kwd lng="en"><![CDATA[Status epilepticus]]></kwd>
<kwd lng="en"><![CDATA[Drug-resistant epilepsy]]></kwd>
<kwd lng="en"><![CDATA[Complementary therapies]]></kwd>
<kwd lng="en"><![CDATA[General anesthetics]]></kwd>
<kwd lng="en"><![CDATA[Anticonvulsants]]></kwd>
<kwd lng="en"><![CDATA[Ketogenic diet]]></kwd>
<kwd lng="en"><![CDATA[Immunotherapy]]></kwd>
<kwd lng="en"><![CDATA[Vagus nerve stimulation]]></kwd>
<kwd lng="en"><![CDATA[Neurosurgery]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Múnera]]></surname>
<given-names><![CDATA[CP]]></given-names>
</name>
<name>
<surname><![CDATA[Lomlomdjian]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Solis]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Medel]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Seoane]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Kochen]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Crossed aphasia after right anterior temporal lobectomy: a case report]]></article-title>
<source><![CDATA[Epilepsy Behav]]></source>
<year>2012</year>
<volume>25</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>125-8</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ruiz Cuero]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Varelas]]></surname>
<given-names><![CDATA[PN]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Super-Refractory status epilepticus]]></article-title>
<source><![CDATA[Curr Neurol Neurosci Rep]]></source>
<year>2015</year>
<volume>15</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>74</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lv]]></surname>
<given-names><![CDATA[RJ]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[Q]]></given-names>
</name>
<name>
<surname><![CDATA[Cui]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Zhu]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Shao]]></surname>
<given-names><![CDATA[XQ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Status epilepticus-related etiology, incidence and mortality: a meta-analysis]]></article-title>
<source><![CDATA[Epilepsy Res]]></source>
<year>2017</year>
<numero>136</numero>
<issue>136</issue>
<page-range>12-7</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Trinka]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Brigo]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Neurostimulation in the treatment of refractory and super-refractory status epilepticus]]></article-title>
<source><![CDATA[Epilepsy Behav]]></source>
<year>2019</year>
<numero>101</numero>
<issue>101</issue>
<page-range>106551</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cervenka]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Hocker]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Koenig]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Bar]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Henry-Barron]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Kossoff]]></surname>
<given-names><![CDATA[EH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Phase I/II multicenter ketogenic diet study for adult superrefractory status epilepticus]]></article-title>
<source><![CDATA[Neurology]]></source>
<year>2017</year>
<volume>88</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>938-43</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Samanta]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Garrity]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Arya]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Refractory and super-refractory status epilepticus]]></article-title>
<source><![CDATA[Indian Pediatr]]></source>
<year>2020</year>
<volume>57</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>239-53</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gaspard]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Foreman]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Judd]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
<name>
<surname><![CDATA[Brenton]]></surname>
<given-names><![CDATA[JN]]></given-names>
</name>
<name>
<surname><![CDATA[Nathan]]></surname>
<given-names><![CDATA[BR]]></given-names>
</name>
<name>
<surname><![CDATA[McCoy]]></surname>
<given-names><![CDATA[BM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Intravenous ketamine for the treatment of refractory status epilepticus: a retrospective multicenter study]]></article-title>
<source><![CDATA[Epilepsia]]></source>
<year>2013</year>
<volume>54</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>1498-503</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[de Brito Sampaio]]></surname>
<given-names><![CDATA[LP]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Ketogenic diet for epilepsy treatment]]></article-title>
<source><![CDATA[Arq Neuro-Psiquiatr]]></source>
<year>2016</year>
<volume>74</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>842-8</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Melvin]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
<name>
<surname><![CDATA[Huntley Hardison]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Immunomodulatory treatments in epilepsy]]></article-title>
<source><![CDATA[Semin Pediatr Neurol]]></source>
<year>2014</year>
<volume>21</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>232-7</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kirmani]]></surname>
<given-names><![CDATA[BF]]></given-names>
</name>
<name>
<surname><![CDATA[Au]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Ayari]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[John]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Shetty]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Delorenzo]]></surname>
<given-names><![CDATA[RJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Super-refractory status epilepticus: prognosis and recent advances in management]]></article-title>
<source><![CDATA[Aging Dis]]></source>
<year>2021</year>
<volume>12</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>1097-119</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dibué-Adjei]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Brigo]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Yamamoto]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Vonck]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Trinka]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Vagus nerve stimulation in refractory and super-refractory status epilepticus - a systematic review]]></article-title>
<source><![CDATA[Brain Stimul]]></source>
<year>2019</year>
<volume>12</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>1101-10</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
