Targeted temperature management of acute encephalopathy without AST elevation

Recent treatment patterns and variations for pediatric acute encephalopathy in Japan

“…Although no medications or therapeutic procedures have been strictly proven to reduce the sequelae of acute encephalopathy, barbiturates and steroids uses are increased during the periods. These may be the results of several recent literature implicating the importance of early aggressive therapies to febrile status epilepticus [16,31,32].…”

“…Despite the relatively high morbidity and mortality of acute encephalopathy, limited evidence is available and there has been no randomized controlled trials for treatments of acute encephalopathy. As a result, the current national guideline for pediatric acute encephalopathy [10] from the Japanese Society for Child Neurology are primarily based on expert consensus and from case series and retrospective case-control studies for specific therapies, such as corticosteroids [5,11], immunoglobulin [12], free-radical scavenger [13], osmotic agents [14], immunosuppressants [15], plasmapheresis, and therapeutic hypothermia [16]. Evaluating and understanding the current clinical practice patterns and their variations are the important first steps to promote prospective observational or interventional trials to create evidence-based treatment guidelines and ultimately improve the morbidity and mortality of acute encephalopathy.…”

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

“…The prognosis was determined using the Pediatric Cerebral Performance Category Scale (PCPC) [11] at the last evaluation, within 30 months of onset, with a PCPC score of 1-2 and 3-6 being de ned as good and poor, respectively. Onset was de ned as the time of initial recognition of neurological symptoms, including convulsions or impaired consciousness, based on previously determined criteria [8,10,12,13].…”

“…Previously, we reported three risk factors for poor outcome as follows: 1) refractory status epilepticus (RSE); 2) prolonged neurological abnormality at 6 hours from onset; and 3) aspartate aminotransferase (AST) > 90 IU/L within 6 hours of onset [8,9]. Moreover, we have previously assessed early speci c treatment according to the aforementioned criteria and found that targeted temperature management (TTM) might be effective in children with suspected acute encephalopathy without AST elevation (> 90 IU/L within 6 hours of onset) [10]. However, its therapeutic effect in patients with elevated AST remains unknown.…”

Brain hypothermia therapy for childhood acute encephalopathy based on clinical evidence

“…Based on the results obtained in the abovementioned study, the brain normal-temperature method or targeted temperature management (TTM) has been recently attempted as a practical treatment method for childhood acute encephalopathy. Brain normal-temperature method or TTM were also employed as treatment methods for maintaining the brain or body temperature at 36° ( 11 ). Currently, however, this procedure remains at the investigation stage, while there is no evidence indicating the obvious effectiveness of TTM.…”