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Therapeutic burst-suppression coma in pediatric febrile refractory status epilepticus

Jainn-Jim Lin1, Cheng-Che Chou2, Shih-Yun Lan2

  • 1Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Chang Gung Children's Hospital Study Group for Children with Encephalitis/Encephalopathy Related Status Epilepticus and Epilepsy (CHEESE), Taoyuan, Taiwan.

Brain & Development
|April 24, 2017
PubMed

Insights

Therapeutic burst-suppression coma for pediatric febrile refractory status epilepticus may increase hemodynamic instability and worsen outcomes. This treatment strategy

Area of Science:

  • Pediatric Neurology
  • Critical Care Medicine
  • Epileptology

Background:

  • Limited evidence exists on the efficacy and outcomes of therapeutic burst-suppression coma for pediatric febrile refractory status epilepticus.
  • The clinical impact of this treatment strategy in children remains largely unknown.

Purpose of the Study:

  • To investigate the clinical outcomes of therapeutic burst-suppression coma in pediatric patients diagnosed with febrile refractory status epilepticus.

Main Methods:

  • Retrospective review of pediatric patients with febrile refractory status epilepticus admitted to a pediatric intensive care unit from 2000 to 2013.
  • Analysis of clinical characteristics and treatment outcomes.

Main Results:

  • Thirty-five pediatric patients were included; 80% developed super-refractory status epilepticus.
  • While 74.3% achieved therapeutic burst-suppression coma, 22.9% died within 1 month.
  • Patients with burst-suppression coma showed increased need for hemodynamic support, a trend towards higher mortality, worse 6-month outcomes, and longer hospitalizations.

Conclusions:

  • Therapeutic burst-suppression coma for febrile refractory status epilepticus may be associated with increased risk of hemodynamic instability.
  • This treatment approach showed a trend towards worse patient outcomes and prolonged hospitalization.
Abstract

Keywords:
ChildrenElectrographic seizuresHemodynamic instabilityPediatric intensive care unit

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