Hypothermia for pediatric refractory status epilepticus

Authors

  • Kristin Guilliams,

    Corresponding author
    1. Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, U.S.A
    2. Division of Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, U.S.A
    • Address correspondence to Kristin Guilliams, 660 S. Euclid Ave Box 8111, St. Louis, MO 63110, U.S.A. E-mail: guilliamsk@neuro.wustl.edu

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  • Max Rosen,

    1. School of Medicine, Washington University in St. Louis, St. Louis, Missouri, U.S.A
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  • Sandra Buttram,

    1. Division of Critical Care Medicine, Department of Child Health, University of Arizona College of Medicine, Phoenix, Arizona, U.S.A
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  • John Zempel,

    1. Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, U.S.A
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  • Jose Pineda,

    1. Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, U.S.A
    2. Division of Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, U.S.A
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  • Barbara Miller,

    1. Division of Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, U.S.A
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  • Michael Shoykhet

    1. Division of Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, U.S.A
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Summary

Purpose

Refractory status epilepticus (RSE) is a life-threatening emergency, demonstrating, by definition, significant pharmacoresistance. We describe five cases of pediatric RSE treated with mild hypothermia.

Methods

Retrospective chart review was performed of records of children who received hypothermia for RSE at two tertiary-care pediatric hospitals between 2009 and 2012.

Key Findings

Five children with RSE received mild hypothermia (32–35°C). Hypothermia reduced seizure burden during and after treatment in all cases. Prior to initiation of hypothermia, four children (80%) received pentobarbital infusions to treat RSE, but relapsed after pentobarbital discontinuation. No child relapsed after treatment with hypothermia. One child died after redirection of care. Remaining four children were discharged.

Significance

This is the largest pediatric case series reporting treatment of RSE with mild hypothermia. Hypothermia decreased seizure burden during and after pediatric RSE and may prevent RSE relapse.

Ancillary