Hypothermia for Neuroprotection in Convulsive Status Epilepticus

Legriel, Stéphane; Lemiale, Virginie; Schenck, Maleka; Chelly, Jonathan; Laurent, Virginie; Daviaud, Fabrice; Srairi, Mohamed; Hamdi, Aïcha; Géri, Guillaume; Rossignol, Thomas; Hilly-Ginoux, Julia; Boisramé-Helms, Julie; Louart, Benjamin; Malissin, Isabelle; Mongardon, Nicolas; Planquette, Benjamin; Thirion, Marina; Merceron, Sybille; Canet, Emmanuel; Pico, Fernando; Tran-Dinh, Yves-Roger; Bédos, Jean‐Pierre; Azoulay, Élie; Resche-Rigon, Matthieu; Cariou, Alain

doi:10.1056/nejmoa1608193

Cited by 154 publications

(102 citation statements)

References 40 publications

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“…Long‐term mortality data after an episode of SE, including in‐hospital deaths, is 0%‐22% in children5, 6, 17, 26, 27, 28, 29, 33, 34, 35, 37, 38, 45, 53 and 0%‐57% in adults 10, 11, 12, 17, 19, 20, 43, 54…”

Section: Long‐term Outcomes Of Sementioning

confidence: 99%

“…37 In contrast, large studies showed no difference in cognitive outcome when comparing children with and without SE, although controls in this study were children with epilepsy. 33,34 Most adult studies focus on functional rather than cognitive outcomes using standardized scales like the modified Rankin Score and the Glasgow Outcome Scale, with functional deficits seen in 21-61%, 16,20,21,43,44 and these could be more severe in RSE 20 or SRSE (67%). 16 Functional outcomes in children are mostly based on clinical impression, yielding a wide spectrum of functional impairment after SE from 0% to 79%, 6,17,24,[26][27][28][29]35,36,38,45 and this range may also be related to different definitions and assessment of impairment, and often lack of good baseline information.…”

Section: Cognitive Outcome and Functional Outcomementioning

confidence: 99%

“…26,48,[50][51][52] Long-term mortality data after an episode of SE, including in-hospital deaths, is 0%-22% in children 5,6,17,[26][27][28][29][33][34][35]37,38,45,53 and 0%-57% in adults. [10][11][12]17,19,20,43,54 Although long-term mortality rates are high, the underlying etiology and the period of followup are major determinants of outcome. A population-based study reported 24 deaths among 150 patients with childhood onset epilepsy, but mortality was similar in those with or without prior SE.…”

Section: Mortalitymentioning

confidence: 99%

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Long‐term outcomes of status epilepticus: A critical assessment

et al. 2018

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SummaryWe reviewed 37 studies reporting long‐term outcomes after a status epilepticus (SE) episode in pediatric and adult populations. Study design, length of follow‐up, outcome measures, domains investigated (mortality, SE recurrence, subsequent epilepsy, cognitive outcome, functional outcome, or quality of life), and predictors of long‐term outcomes are summarized. Despite heterogeneity in the design of prior studies, overall risk of poor long‐term outcome after SE is high in both children and adults. Etiology is the main determinant of outcome, and the effect of age or SE duration is often difficult to distinguish from the underlying cause. The effect of the treatment on long‐term outcome after SE is still unknown.

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Section: Long‐term Outcomes Of Sementioning

confidence: 99%

Section: Cognitive Outcome and Functional Outcomementioning

confidence: 99%

Section: Mortalitymentioning

confidence: 99%

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Long‐term outcomes of status epilepticus: A critical assessment

et al. 2018

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“…A randomized controlled trial and several reports showed that TTM (32–35 °C) for 24 h was associated with a better control of electrical seizure activity and achievement of burst-suppression pattern [132–134]. In the HYBERNATUS trial, the rate of progression to EEG-confirmed status epilepticus was lower in the hypothermia group than in the control group (11 vs. 22%; odds ratio, 0.40; 95% CI 0.20–0.79; P = 0.009) [135]. …”

Section: Resultsmentioning

confidence: 99%

Targeted temperature management in the ICU: guidelines from a French expert panel

Cariou

Payen

Asehnoune

et al. 2017

Ann. Intensive Care

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Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term “targeted temperature management” (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method. Indications are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of TTM in adult and paediatric critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d’Anesthésie Réanimation [SFAR]) with the participation of the French Emergency Medicine Association (Société Française de Médecine d’Urgence [SFMU]), the French Group for Pediatric Intensive Care and Emergencies (Groupe Francophone de Réanimation et Urgences Pédiatriques [GFRUP]), the French National Association of Neuro-Anesthesiology and Critical Care (Association Nationale de Neuro-Anesthésie Réanimation Française [ANARLF]), and the French Neurovascular Society (Société Française Neurovasculaire [SFNV]). Fifteen experts and two coordinators agreed to consider questions concerning TTM and its practical implementation in five clinical situations: cardiac arrest, traumatic brain injury, stroke, other brain injuries, and shock. This resulted in 30 recommendations: 3 recommendations were strong (Grade 1), 13 were weak (Grade 2), and 14 were experts’ opinions. After two rounds of rating and various amendments, a strong agreement from voting participants was obtained for all 30 (100%) recommendations, which are exposed in the present article.

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“…A randomized trial in children is planned [38]. A recent trial of hypothermia showed no benefit at 90 days [39]. …”

Section: Status Epilepticus and Limbic Encephalitismentioning

confidence: 99%

Recent advances in epilepsy

2017

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This paper reviews advances in epilepsy in recent years with an emphasis on therapeutics and underlying mechanisms, including status epilepticus, drug and surgical treatments. Lessons from rarer epilepsies regarding the relationship between epilepsy type, mechanisms and choice of antiepileptic drugs (AED) are explored and data regarding AED use in pregnancy are reviewed. Concepts evolving towards a move from treating seizures to treating epilepsy are discussed, both in terms of the mechanisms of epileptogenesis, and in terms of epilepsy’s broader comorbidity, especially depression.

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Hypothermia for Neuroprotection in Convulsive Status Epilepticus

Abstract: In this trial, induced hypothermia added to standard care was not associated with significantly better 90-day outcomes than standard care alone in patients with convulsive status epilepticus. (Funded by the French Ministry of Health; HYBERNATUS ClinicalTrials.gov number, NCT01359332 .).

Cited by 154 publications

References 40 publications

Long‐term outcomes of status epilepticus: A critical assessment

Long‐term outcomes of status epilepticus: A critical assessment

Targeted temperature management in the ICU: guidelines from a French expert panel

Recent advances in epilepsy

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