Abstract Details

Title Safe and effective use of prolonged, 4-week therapeutic hypothermia for super-refractory status epilepticus.

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-075

Objective NA

Background Based on animal studies and clinical experience, there exists anecdotal evidence for therapeutic hypothermia as a treatment option for seizures in refractory status epilepticus. The common target temperature in these studies was 33 °C, sustained for a median of 48 hours, utilizing external cooling. We would like to report a patient treated with therapeutic hypothermia, maintained for 4-weeks along with midazolam infusion, resulting in successful seizure control.

Design/Methods NA

Results A 19-year-old woman was hospitalized for new-onset refractory status epilepticus, who was subsequently diagnosed with anti-NMDA receptor encephalitis, related to bilateral ovarian teratomas. She required multiple anti-seizure medications, Pentobarbital coma for 2-months, along with immunotherapy and bilateral oophorectomy. The course was complicated by hepatic failure, limiting use of Pentobarbital, Valproate, and Propofol. At that point, therapeutic hypothermia with target temperature of 33 °C was initiated, which was then continued for total 4 weeks, as seizures reappeared on attempted slow rewarming after 1 week. With the introduction of hypothermia, the electrographic seizures resolved. Upon recovery of hepatic function, she was rewarmed and Pentobarbital infusion was resumed. Repeat brain MRI after hypothermia treatment was reported normal, without any sequela of prolonged seizures.

Conclusions Adequate seizure control in refractory status epilepticus of autoimmune etiology can be challenging, especially considering that immunotherapy takes time to be effective. Treatment options may further be truncated by coexistent systemic complications like hepatic or renal failure. Based on our case, we suggest utilization of prolonged therapeutic hypothermia, while the immunotherapy becomes effective and systemic metabolic parameters stabilize. We were able to maintain hypothermia for 4 weeks with no apparent complications. Close monitoring of cardiovascular indices, coagulation parameters, and monitoring for infections and paralytic ileus during this period would be recommended.

Authors/Disclosures
Jae Eun Lee, MD (Graves Gilbert Clinic) PRESENTER	Dr. Lee has nothing to disclose.
Umar A. Shuaib, MBBS (Cleveland Clinic)	Dr. Shuaib has nothing to disclose.
Ajaz Sheikh, MD (ProMedica Neurosciences Center)	Dr. Sheikh has nothing to disclose.

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