Midazolam Fails to Prevent Neurological Damage in Children With Convulsive Refractory Febrile Status Epilepticus

Journal of the Neurological Sciences

Nishiyama

Tokumoto

et al. 2020

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Objective: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a syndrome characterized by biphasic seizures with impaired consciousness. AESD is rare outside Asia, and consecutive cohort studies are therefore scarce. Herein, we aimed to describe the detailed characteristics of AESD, including clinical course, electroencephalogram data, laboratory data, imaging findings, treatment, and outcomes. Methods:We reviewed the clinical database and medical charts of 43 consecutive pediatric patients (<18 years old) who developed AESD between October 1, 2002, and September 30, 2019. Results: We found that AESD occurred even though patients did not develop prolonged seizures. A comparison between the two groups (first seizure duration <30 min and first seizure duration ≥30 min) revealed three main findings: first, patients with AESD who had shorter seizures had better prognosis than those with prolonged seizures; second, patients with AESD who had shorter seizures tended to have earlier occurrence of a second seizure; and third, high signal intensity on diffusion-weighted magnetic resonance imaging was observed mainly in frontal areas, not diffusely, in patients with shorter seizures, and in a broader area in patients with prolonged seizures. Conclusions: Our description of the detailed clinical picture of AESD may add new insight into its pathophysiology.

Section: Discussionmentioning

confidence: 99%

Detailed characteristics of acute encephalopathy with biphasic seizures and late reduced diffusion: 18-year data of a single-center consecutive cohort

Journal of the Neurological Sciences

Nishiyama

Tokumoto

et al. 2020

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“…In addition, our case highlights targeted temperature management and/or barbiturate coma therapy for preventing biphasic seizures and neurologic sequelae. These treatments are effective in preventing the damage caused by refractory febrile convulsive status epilepticus or acute encephalopathy [ 14 , 15 ] and could likely prevent secondary seizures as well. Unfortunately, because of the hemodynamic instability, we could not perform barbiturate coma therapy as we normally would have in such a case as this.…”

Section: Discussionmentioning

confidence: 99%

Septic Encephalopathy Characterized by Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion and Early Nonconvulsive Status Epilepticus

Case Reports in Neurological Medicine

Tanaka

Maruyama

et al. 2016

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Infection, whether viral or bacterial, can result in various forms of brain dysfunction (encephalopathy). Septic encephalopathy (SE) is caused by an excessive immune reaction to infection, with clinical features including disturbed consciousness and seizures. Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is usually accompanied by viral infection in children and is characterized by biphasic seizures and impaired consciousness. The initial neurologic symptom of AESD is typically a febrile seizure that frequently lasts longer than 30 minutes. However, the possible forms this seizure takes are unclear. For example, it is unknown if nonconvulsive status epilepticus (NCSE) could be an early seizure symptomatic of AESD. In addition, thus far no cases of combined SE and AESD have been reported. Here, we describe the first reported case of SE with AESD that notably demonstrated NCSE as an early seizure.

“…Propofol can cause propofol infusion syndrome; therefore, attention is needed, especially in children [1]. In a comparison of midazolam and barbiturates, Nagase et al reported that barbiturate anaesthetic therapy had a better neurological outcome than intravenous midazolam infusion in paediatric fRSE [38], which supports our selection of barbiturate administration, as opposed to midazolam, as an anaesthetic agent. Pentobarbital, thiopental, and thiamylal are frequently used barbiturates.…”

Section: Discussionmentioning

confidence: 60%

Thiamylal anaesthetic therapy for febrile refractory status epilepticus in children

Ishida

Nishiyama

et al. 2020

Seizure

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To evaluate barbiturate anaesthetic therapy using thiamylal for febrile refractory status epilepticus (fRSE) in children. Methods: This was a review of a prospectively-collected database between April 2012-March 2016 for fRSE cases treated with thiamylal anaesthetic therapy in a single paediatric hospital in Japan. The sample comprised 23 children (median age, 23 months) with fRSE that underwent thiamylal anaesthetic therapy for convulsive seizures lasting longer than 60 min, sustained after intravenous administration of benzodiazepine and non-benzodiazepine anticonvulsants. The intervention comprised protocol-based thiamylal anaesthetic therapy with bolus administration. We measured the dose and time required to achieve the burst suppression pattern (BSP) on electroencephalography, seizure recurrence, death, neurological sequelae, and complications. Results: All patients except one reached the BSP. The thiamylal median dose until reaching the BSP was 27.5 mg/kg, and the median time from thiamylal administration to reaching the BSP was 109.5 min. There was one case of immediate treatment failure and one of withdrawal seizure, but no breakthrough seizure. No deaths occurred during treatment, and neurological sequelae occurred in four cases (17%). Vasopressors were administered in all cases. Other complications included 11 cases of pneumonia and one of enterocolitis. Conclusion:We revealed the time and dose required to reach the BSP with thiamylal anaesthetic therapy using bolus administration in children. Our results suggested that reaching the BSP with bolus administration requires markedly less time than without bolus administration, rarely causes seizure recurrence in paediatric fRSE, and causes haemodynamic dysfunction and infections as often as observed without bolus administration.