Does the Benefit of Therapeutic Hypothermia in Refractory Status Epilepticus Depend on Seizure Etiology?

Abstract

Introduction Seizure activity that persists despite acute administration of standard anticonvulsant therapy is termed refractory status epilepticus (RSE). RSE can be seen post-cardiac arrest and is a poor prognostic indicator. Therapeutic hypothermia (TH) has been shown to reduce neurological injury post-cardiac arrest, but is not routinely used in RSE from other etiologies. Methods Five consecutive patients with RSE admitted to our neurocritical care unit treated with TH (target temperature 33 °C) were retrospectively reviewed. Three patients had anoxic brain injury post-cardiac arrest and two had epilepsy secondary to remote traumatic brain injury. All five patients received similar medical treatment for status epilepticus. Results The two post-traumatic epilepsy patients became seizure free after completion of TH and remained seizure free after rewarming. Both had good neurological recovery and were discharged for rehabilitation. Seizures persisted despite TH with the three post-cardiac arrest patients who later expired. Conclusions Patients with RSE caused by etiologies other than anoxic brain injury post-cardiac arrest may have better outcomes with TH, as supported by our two patients with RSE from post-traumatic epilepsy. The benefits of TH in RSE may be linked to the etiology of the seizures. Further studies are needed to evaluate RSE from a variety of causes to determine which groups would benefit from TH.