Summary
A study published in the Biomedical Journal shows that therapeutic hypothermia — based on lowering the body’s temperature — can shorten the duration of long-lasting seizures in drug-resistant forms of epilepsy, including Dravet syndrome.
Refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) are two of the most severe types of drug-resistant convulsive seizures. RSE seizures are those lasting more than one hour despite treatment with first- and second-line AEDs, while SRSE seizures last or return over a period of more than 24 hours after the patient is placed under general anesthesia. Both RSE and SRSE seizures are normally managed with anesthetic agents like propofol, midazolam, barbiturate, or ketamine, but these medications achieve a therapeutic effect in only 64–78% of patients. Thus, alternative therapeutic approaches with better efficacies are needed for patients with RSE/SRSE,” the researchers wrote.
Therapeutic hypothermia (TH), a form of therapy used to prevent organ and neuronal damage, has previously been used as a complementary treatment for RSE seizures.
However, studies assessing TH’s effectiveness in controlling seizures have had variable results, particularly those concerning children. Thus, a team of researchers in Taiwan carried out a retrospective study to compare clinical outcomes between a group of children experiencing RSE/SRSE seizures and given TH therapy with a group who were not.
Children given therapeutic hypothermia as an add-on therapy had shorter seizures compared to those who only received anticonvulsants (an average of 24 hours vs. 96 hours). Moreover, children in the TH group had milder neurological impairments compared with those in the control group, indicative of better long-term clinical outcomes. Later chronic refractory epilepsy was reported in less than half (45%) of the TH group children, whereas all in the control group developed this form of epilepsy after one year of follow-up. Duration of stay in a pediatric intensive care unit was similar in both groups.
According to the researchers, therapeutic hypothermia was found to be “safe for use in pediatric patients with RSE/SRSE.” This study shows that “shortened seizure durations in the acute symptomatic phase of SE can reduce the occurrence of post-status epilepticus epilepsy and improve patients’ long-term functional outcomes.”