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Published on: June 2, 2015
Adjunctive remote ischaemic postconditioning and hypothermia therapy in acute encephalopathy with biphasic seizures
Go Kawano1, Nobuoki Eshima2, Kota Nagai2
1Department of Paediatrics, St Mary's Hospital, Kurume, Fukuoka, Japan. g-kawano@st-mary-med.or.jp.
Insights
Remote ischaemic postconditioning (RIPoC) combined with therapeutic hypothermia is safe and feasible for children with acute encephalopathy with biphasic seizures and late reduced diffusion (AESD). This neuroprotective therapy showed potential for improved outcomes in pediatric brain injury.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Ischemic Conditioning
Background:
- Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a common pediatric condition triggered by infections.
- Therapeutic hypothermia is a standard treatment for AESD.
- The study investigates novel adjunct therapies for AESD.
Purpose of the Study:
- To evaluate the safety and feasibility of remote ischaemic postconditioning (RIPoC) as an adjunct to therapeutic hypothermia in pediatric patients with AESD.
- To compare neurological outcomes between patients receiving RIPoC and those receiving standard care.
Main Methods:
- Prospective study comparing RIPoC group (n=15) with historical controls (n=12) receiving therapeutic hypothermia.
- RIPoC involved four 5-minute cycles of cuff inflation/deflation on the lower extremity.
- Adverse events and neurological outcomes at 6-18 months were assessed; multivariate analyses identified outcome predictors.
Main Results:
- No significant differences in adverse events or neurological outcomes were observed between the RIPoC and control groups.
- Multivariate analysis indicated that a lower Tada score and RIPoC treatment were associated with better neurological outcomes.
- This is the first study to report on RIPoC feasibility and safety in pediatric CNS disease not directly related to ischemia-reperfusion injury.
Conclusions:
- Remote ischaemic postconditioning (RIPoC) is safe and feasible when combined with therapeutic hypothermia in pediatric AESD patients.
- RIPoC showed no adverse events, including coagulation or hemodynamic complications.
- Findings support further randomized controlled trials to establish RIPoC as an adjunctive neuroprotective therapy for pediatric brain injury, especially AESD.
Background:
Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a common form of acute infection-triggered encephalopathy in children. This study aimed to evaluate the safety and feasibility of remote ischaemic postconditioning (RIPoC) as an adjunct to therapeutic hypothermia in patients with AESD.
Methods:
In this prospective, non-randomised study, patients treated in January 2021-July 2024 were compared with a historical control group treated in January 2017-December 2020. RIPoC (four cycles of 5-min inflation and 5-min deflation) was applied to the lower extremity at the initiation of therapeutic hypothermia. Adverse events were assessed between the RIPoC group (n = 15) and patients with therapeutic hypothermia in the control groups (n = 12). Neurological outcomes at 6-18 months post-onset were compared between the RIPoC group (n = 12) and patients with/without therapeutic hypothermia in the control groups (n = 13). Multivariate analyses were performed to identify predictors of favourable neurological outcomes.
Results:
While the comparison of adverse events and neurological outcomes between groups did not show significant differences, multiple analysis suggested associations between a lower Tada score or RIPoC treatment and better outcomes.
Conclusion:
RIPoC combined with therapeutic hypothermia appears safe and feasible in patients with AESD.
Impact:
Remote ischaemic postconditioning (RIPoC) was safely combined with hypothermia in paediatric patients with acute encephalopathy with biphasic seizures and late reduced diffusion (AESD). No coagulation, hemodynamic complications, or adverse events were observed. Multiple linear regression analysis suggested associations between a lower Tada score or RIPoC treatment and better outcomes in patients with AESD. This is the first report to examine the feasibility and safety of the RIPoC in paediatric central nervous system disease not directly related to ischaemia-reperfusion injury. Findings support future randomised controlled studies to confirm RIPoC as a possible adjunctive neuroprotective therapy in paediatric brain injury, particularly AESD.
