Therapeutic hypothermia for pediatric refractory status epilepticus May Ameliorate post-status epilepticus epilepsy

Abstract

Background To compare the clinical characteristics and outcomes of pediatric patients with refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) who received therapeutic hypothermia (TH) plus anticonvulsants or anticonvulsants alone. Methods Two-medical referral centers, retrospective cohort study. Pediatric Intensive Care Unit (PICU) at Taoyuan Chang Gung Children's hospital and Kaohsiung Chang Gung Memorial Hospital. We reviewed the medical records of 23 patients with RSE/SRSE who were admitted to PICU from January 2014 to December 2017. Of these, 11 patients received TH (TH group) and 12 patients did not (control group). Results The selective endpoints were RSE/SRSE duration, length of PICU stay, and Glasgow Outcome Scale (GOS) score. We applied TH using the Artic Sun® temperature management system (target temperature, 34–35 °C; duration, 48–72 h). Of the 11 patients who received TH, 7 had febrile infection-related epilepsy syndrome (FIRSE), one had Dravet syndrome, and three had traumatic brain injury. The TH group had significantly shortern seizure durations than did the control group (hrs; median (IQR) 24(40) vs. 96(90), p < 0.05). Two patients in the TH group died of pulmonary embolism and extreme brain edema. The length of PICU stay was similar between the groups (days; median (IQR) 30(42) v.s 30.5(30.25)). The TH group had significantly better long-term outcomes than did the control group (GOS score, median (IQR) 4(2) v.s 3 (0.75), p = 0.01∗). The TH group had a significantly lower incidence of later chronic refractory epilepsy than did the control group (TH v.s non-TH, 5/11 (45%) v.s. 12/12(100%), p < 0.01). Conclusions TH effectively reduced the seizure burden in patients with RSE/SRSE. Our findings support that for patients with RSE/SRSE, TH shortens the seizure duration, ultimately reducing the occurrence of post-status epilepticus epilepsy and improving patients’ long-term survival.

International consensus recommendations for management of new onset refractory status epilepticus including febrile infection‐related epilepsy syndrome: Statements and supporting evidence

“…Furthermore, in a retrospective case series, 11 children with RSE treated with hypothermia had a decrease of seizure duration and showed improved long‐term outcomes compared to those without hypothermia. However, the specific effect of hypothermia on seizures in FIRES was difficult to ascertain; therefore, any definitive conclusions are difficult to draw 105 . A review of case series of SRSE in adults and children found hypothermia to be effective in controlling seizures in 82% of patients irrespective of their etiology.…”

FIRES – Pathophysiologie, therapeutischer Ansatz und Folgen

“…By protecting the BBB integrity and reducing pro-inflammatory cytokines, TH may work toward the control of SE [11]. In a retrospective Taiwanese [17] study, seven patients with FIRES were managed for a few days with hypothermia (34-35°) and showed a significantly shorter duration of seizures, a better long-term outcome, and lower incidence of later refractory chronic epilepsy. Complications of hypothermia were bradycardia and electrolyte imbalance.…”

Protecting the blossoming brain – Neurocritical care in children

“…To note, this issue contains additionally two original articles by the author's department, reporting encouraging first results regarding the use of TTM for the treatment of paediatric refractory status epilepticus [ 37 ], as well as the predictive value of seizure patterns during rewarming after TTM in neonates with hypoxic-ischaemic encephalopathy [ 38 ].…”

“…Here, Hsu et al. from the above-mentioned department conducted a retrospective cohort study on paediatric patients with refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) [ 48 ], who received either anticonvulsants alone, or in combination with therapeutic hypothermia (TH) [ 37 ], for the purpose of comparing their clinical characteristics and outcomes.…”