Hypothermia as an adjuvant treatment in paediatric refractory or super‐refractory status epilepticus

Abstract

Therapeutic hypothermia is among the adjuvant therapies suggested for refractory or super‐refractory status epilepticus (R/SR‐SE) in paediatric patients. Experimental evidence of neuroprotective and antiseizure effects provides a strong rationale for using therapeutic hypothermia in patients with status epilepticus. Thus, hypothermia between 20°C and 33°C in animals with status epilepticus is associated not only with significantly less neuronal damage, predominantly in the hippocampal CA1, CA2, and CA3 areas, but also with increased seizure latency and decreased seizure frequency and duration. Therapeutic hypothermia has rarely been used in paediatric R/SR‐SE. In the few reported cases, seizure control was markedly improved but nearly half the patients experienced recurrences after rewarming. Studies are needed to clarify the modalities and indications of therapeutic hypothermia in paediatric patients with R/SR‐SE. What this paper adds Hypothermia at 20°C to 33°C is neuroprotective and has antiseizure effects in experimental status epilepticus. In children, antiseizure effects are marked but recurrences after rewarming are common.

Epileptic Seizures in Critically Ill Patients: Diagnosis, Management, and Outcomes

“…Beyond the unspecific management description, we do not really know who to treat and when to treat them with regard to epileptic seizures in critically ill patients, nor what the most efficient treatments are [ 19 , 20 , 21 ]. The role of general anesthesia and which agents should be used remains debated, just like the place of adjuvant anticonvulsant and neuroprotective strategies [ 22 , 23 , 24 ]. Furthermore, additional progress needs to be made to define the roles and interactions between the protagonists involved in the management of these patients: nurses, emergency physicians, intensivists, neurointensivists, neurologists, and neurophysiologists [ 25 , 26 ].…”