Tocilizumab in pediatric refractory status epilepticus and acute epilepsy: Experience in two patients

Interleukin-6 Blockade With Tocilizumab in Anakinra-Refractory Febrile Infection-Related Epilepsy Syndrome (FIRES)

“…7 Two children with FIRES experienced a decrease in seizures after two 4mg/kg doses of tocilizumab without side effects. 8 Given the multiple treatments received, causality of our patient's improvement is uncertain, but tocilizumab and KD were most temporally associated with seizure resolution. IL-6 elevation was CNS-restricted, prohibiting non-invasive trending of IL-6 blockade.…”

“…7 Two children with FIRES experienced a decrease in seizures after two 4mg/kg doses of tocilizumab without side effects. 8…”

“…6 Tocilizumab, an IL-6 receptor antagonist, has been reported in 7 NORSE and 2 FIRES cases, but not with prior anakinra failure. 7,8 We present a case of anakinra-refractory FIRES treated with ketosis and tocilizumab with temporally related cessation of SRSE and favorable 1-year outcome.…”

Super refractory status epilepticus secondary to anti-GAD antibody encephalitis successfully treated with aggressive immunotherapy

“…Tocilizumab is an anti-interleukin 6 monoclonal antibody with direct impact on plasma cell survival, and therefore antibody production. Initiation of tocilizumab was followed by rapid and sustained improvement in previously reported cases with refractory autoimmune encephalitis [26] , [27] , [28] , [29] . Earlier treatment and escalation to second-line treatments are associated with better outcome in children.…”

Resolution of cryptogenic new onset refractory status epilepticus with tocilizumab

“…Tocilizumab therapy for patients with status epilepticus has been limited to case series and case reports [5] , [6] , [7] , [8] . One prospective cohort study of seven adult patients with NORSE secondary autoimmune encephalitis was treated with two doses of tocilizumab (4 mg/kg) at least one week apart.…”