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

Mei-Hsin Hsu1, Hsuan-Chang Kuo2, Jainn-Jim Lin3

  • 1Division of Pediatric Critical Care, Department of Pediatrics at Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Biomedical Journal
|April 25, 2020
PubMed

Insights

Therapeutic hypothermia (TH) significantly reduced seizure duration in pediatric patients with refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE). TH also improved long-term outcomes and reduced chronic epilepsy incidence.

Area of Science:

  • Neurology
  • Pediatric Intensive Care
  • Critical Care Medicine

Background:

  • Refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) are severe neurological emergencies in children.
  • Effective treatment strategies for RSE/SRSE remain a critical clinical challenge.
  • Therapeutic hypothermia (TH) is an adjunctive therapy explored for managing these conditions.

Purpose of the Study:

  • To compare clinical characteristics and outcomes of pediatric RSE/SRSE patients treated with TH plus anticonvulsants versus anticonvulsants alone.
  • To evaluate the efficacy of TH in reducing seizure burden and improving patient outcomes.

Main Methods:

  • A retrospective cohort study was conducted across two medical referral centers.
  • Medical records of 23 pediatric patients with RSE/SRSE admitted to the Pediatric Intensive Care Unit (PICU) between 2014 and 2017 were reviewed.
  • 11 patients received TH (34-35°C for 48-72 hours), while 12 did not (control group).

Main Results:

  • The TH group demonstrated significantly shorter seizure durations (median 24 hours) compared to the control group (median 96 hours).
  • Long-term outcomes, assessed by the Glasgow Outcome Scale (GOS), were significantly better in the TH group (median GOS 4) versus the control group (median GOS 3).
  • The incidence of later chronic refractory epilepsy was significantly lower in the TH group (45%) than in the control group (100%).

Conclusions:

  • Therapeutic hypothermia effectively reduces seizure burden in pediatric patients with RSE/SRSE.
  • TH shortens seizure duration, leading to a decreased occurrence of post-status epilepticus epilepsy.
  • The findings support TH as a beneficial intervention for improving long-term survival and outcomes in RSE/SRSE patients.
Abstract

Keywords:
Febrile infection-related epilepsy syndromePediatric refractory status epilepticusPharmacoresistant refractory status epilepticusPost-status epilepticus epilepsyTemperature management systemTherapeutic hypothermia

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