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Therapeutic Hypothermia for Refractory Status Epilepticus
Frederick A Zeiler1, Kaitlin J Zeiler2, Jeanne Teitelbaum2
11Section of Neurosurgery,McGill,Montreal,Canada.
Summary
Therapeutic hypothermia effectively controls seizures in refractory status epilepticus (RSE), with a 62.5% cessation rate. Further research is needed to confirm these findings for RSE treatment.
Area of Science:
- Neurology
- Critical Care Medicine
- Evidence-Based Medicine
Background:
- Refractory status epilepticus (RSE) presents a significant clinical challenge.
- Limited evidence exists on the efficacy of therapeutic hypothermia for RSE seizure control.
Purpose of the Study:
- To systematically review the literature on therapeutic hypothermia for RSE.
- To assess the impact of therapeutic hypothermia on seizure control in RSE patients.
Main Methods:
- Comprehensive literature search across multiple databases (MEDLINE, EMBASE, etc.) and gray literature.
- Inclusion of 13 studies (10 manuscripts, 3 abstracts) involving 40 patients.
- Evidence strength adjudicated using Oxford and GRADE methodologies by two independent reviewers.
Main Results:
- Therapeutic hypothermia, typically targeting 33°C for 48 hours, achieved seizure cessation in 62.5% of patients.
- Seizure reduction was observed in 15% of patients, with treatment failure in 22.5%.
- Common complications included deep venous thrombosis, coagulopathy, and infections; external cooling was the primary method.
Conclusions:
- Current evidence (Oxford level 4, GRADE D) suggests therapeutic hypothermia is beneficial for RSE seizure control.
- The findings support the use of therapeutic hypothermia as an adjunctive therapy for RSE.
- Further prospective studies are warranted to strengthen the evidence base.
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