Case Report: Successful multimodal management of FIRES in a pediatric patient using anakinra, ketogenic diet, and induced hypothermia

Mariagiovanna Caporale ¹, Giulia Lais ¹, Antonio Gulli' ¹

⁰Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Fondazione "Policlinico Universitario A. Gemelli" IRCCS, Rome, Italy.

Frontiers in Pediatrics +

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November 26, 2025

View abstract on PubMed

Summary

Febrile infection-related epilepsy syndrome (FIRES) is a severe condition in children. A multimodal approach combining immunotherapy and a ketogenic diet led to full recovery in a refractory case.

Area Of Science

Pediatric Neurology
Epileptology
Neuroimmunology

Background

Febrile infection-related epilepsy syndrome (FIRES) is a rare, severe epileptic encephalopathy in children.
It presents as refractory status epilepticus following a febrile illness.
Optimal management strategies for FIRES remain elusive.

Purpose Of The Study

To report a case of FIRES in a previously healthy child.
To evaluate the efficacy of a multimodal treatment approach.
To highlight the importance of prompt diagnosis and interdisciplinary care.

Main Methods

Diagnostic workup including lumbar puncture, blood tests, EEG, and MRI.
Treatment involved corticosteroids, immunoglobulins, ketogenic diet, and hypothermia.
Etiological investigation included autoimmunity and infectious disease panels.

Main Results

Conventional antiepileptic drugs were ineffective.
The patient responded well to immunosuppressive therapy and ketogenic diet.
Full recovery with mild neurocognitive sequelae was achieved.

Conclusions

A timely, multimodal therapeutic approach is beneficial for FIRES.
Immunomodulation and metabolic support (ketogenic diet) show promise.
Early intervention and interdisciplinary care are crucial for improving outcomes.

Keywords:

anakinra antiepileptic drugs febrile illness-related epilepsy syndrome induced hypothermia ketogenic diet new onset refractory status epilepticus refractory epilepsy