Targeted temperature management for acute encephalopathy in a Japanese secondary emergency medical care hospital

Murata, Shinichi; Kashiwagi, Masayuki; Tanabe, Takuya; Oba, Chizu; Shigehara, Seiji; Yamazaki, Satoshi; Ashida, Atsuko; Sirasu, Akihiko; Inoue, Kazuo; Okasora, Keisuke; Tamai, Hiroshi

doi:10.1016/j.braindev.2015.09.003

Cited by 18 publications

(13 citation statements)

References 16 publications

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“…Previously, we reported that clinical symptoms were dramatically worsened between a few and 13 hours from onset in a review on fatal acute encephalopathy [13] . Taken together with the above report and previous reports regarding treatment time-windows for various neuro-critical conditions including hypoxia, stroke, status epilepticus, and acute encephalopathy, [20–25] we hypothesize that very early intervention within several hours is needed for neuroprotection in severe acute encephalopathy. Therefore, in this report, we examined the relationship between prognosis and time from onset to starting steroid pulse therapy.…”

Section: Discussionsupporting

confidence: 74%

Early steroid pulse therapy for children with suspected acute encephalopathy

et al. 2021

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Steroid pulse therapy is widely used to treat virus-associated acute encephalopathy, especially the cytokine storm type; however, its effectiveness remains unknown. We sought to investigate the effectiveness of early steroid pulse therapy for suspected acute encephalopathy in the presence of elevated aspartate aminotransferase (AST) levels.We enrolled children admitted to Hyogo Children's Hospital between 2003 and 2017 with convulsions or impaired consciousness accompanied by fever (temperature >38°C). The inclusion criteria were: refractory status epilepticus or prolonged neurological abnormality or hemiplegia at 6 hours from onset, and AST elevation >90 IU/L within 6 hours of onset. We excluded patients with a neurological history. We compared the prognosis between the groups with or without steroid pulse therapy within 24 hours. A good prognosis was defined as a Pediatric Cerebral Performance Category Scale (PCPC) score of 1-2 at the last evaluation, within 30 months of onset. Moreover, we analyzed the relationship between prognosis and time from onset to steroid pulse therapy.Fifteen patients with acute encephalopathy and 5 patients with febrile seizures were included in this study. Thirteen patients received steroid pulse therapy within 24 hours. There was no between-group difference in the proportion with a good prognosis. There was no significant correlation between PCPC and timing of steroid pulse therapy (rs = 0.253, P = .405). Even after excluding 2 patients with brainstem lesions, no significant correlation between PCPC and steroid pulse therapy timing (rs = 0.583, P = .060) was noted. However, the prognosis tended to be better in patients who received steroid pulse therapy earlier.Steroid pulse therapy within 24 hours did not improve the prognosis in children with suspected acute encephalopathy associated with elevated AST. Still, even earlier administration of treatment could prevent the possible neurological sequelae of this condition.

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Section: Discussionsupporting

confidence: 74%

Early steroid pulse therapy for children with suspected acute encephalopathy

et al. 2021

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show abstract

“…Previously, we reported that clinical symptoms were dramatically worsened between a few and 13 hours from onset in a review on fatal acute encephalopathy [13]. Taken together with the above report and previous reports regarding treatment time-windows for various neuro-critical conditions including hypoxia, stroke, status epilepticus, and acute encephalopathy [20][21][22][23][24][25], we hypothesize that very early intervention within several hours is needed for neuroprotection in severe acute encephalopathy. Therefore, in this report, we examined the relationship between prognosis and time from onset to starting steroid pulse therapy.…”

Section: Discussionsupporting

confidence: 73%

Early steroid pulse therapy for children with suspected acute encephalopathy: A historical cohort study

Ishida

Nishiyama

Yamaguchi

et al. 2020

Preprint

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Background Steroid pulse therapy is widely used for virus-associated acute encephalopathy, especially the cytokine storm type; however, its effectiveness remains unknown. We aimed to investigate the effectiveness of early steroid pulse therapy for suspected acute encephalopathy in the presence of elevated aspartate aminotransferase (AST) levels. Methods We enrolled children admitted to Hyogo Children's Hospital between 2003 and 2017 with convulsions or impaired consciousness accompanied by fever (temperature > 38˚C). The inclusion criteria were: refractory status epilepticus or prolonged neurological abnormality or hemiplegia at six hours from onset, and AST elevation > 90 IU/L within six hours of onset. We excluded patients with a neurological history. We compared the prognosis between the groups with or without steroid pulse therapy within 24 hours. A good prognosis was defined as a Pediatric Cerebral Performance Category Scale (PCPC) score of 1–2 at the last evaluation, within 30 months of onset. Moreover, we analyzed the relationship between prognosis and time from onset to steroid pulse therapy. Results Fifteen patients with acute encephalopathy and five patients with febrile seizures were included in this study. Thirteen patients received steroid pulse therapy within 24 hours. There was no between-group difference in the proportion with a good prognosis. There was no significant correlation between PCPC and timing of steroid pulse therapy (rs = 0.253, p = 0.405). Conclusions Steroid pulse therapy within 24 hours did not improve the prognosis in children with suspected acute encephalopathy associated with AST elevation.

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“…In fact, most of our patients did not develop neurologic sequelae or mild neurologic sequelae, and no patient died. Some studies also reported that early introduction of TTM immediately after febrile status epilepticus (FSE) may reduce the occurrence of AESD [17,18]. However, the most important limitation of TTM therapy is that it is difficult to differentiate AESD from FSE at the early acute stage, and FSE may be treated unnecessarily with TTM.…”

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

Yamaguchi

Nishiyama

Tokumoto

et al. 2020

Journal of the Neurological Sciences

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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.

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Targeted temperature management for acute encephalopathy in a Japanese secondary emergency medical care hospital

Cited by 18 publications

References 16 publications

Early steroid pulse therapy for children with suspected acute encephalopathy

Early steroid pulse therapy for children with suspected acute encephalopathy

Early steroid pulse therapy for children with suspected acute encephalopathy: A historical cohort study

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

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