Mild hypothermia for refractory focal status epilepticus in an infant with hemimegalencephaly.
Hypothermia can reduce seizure frequency in animal models of status epilepticus, and its effectiveness in human status epilepticus has been reported occasionally. We report an infant with hemimegalencephaly who presented with generalized status epilepticus. After high dose intravenous drug therapy, this converted to focal status epilepticus in the right occipital region. A sudden cessation of all seizure activity was found to coincide with accidental hypothermia. After application of mild continuous hypothermia, a marked reduction of seizure frequency occurred, which allowed reduction of intravenous drug doses and discharge from the IC unit. Ultimately, hemispherectomy was needed to achieve long term seizure control. The therapeutic effect of hypothermia should be further investigated in patients with refractory status epilepticus. When used in combination with anti-epileptic drugs, seizure control may be achieved at lower doses. Hypothermia may obviate the need for potentially dangerous barbiturate therapy. This case demonstrates that even a mild degree of hypothermia (+/-36 degrees C) can be remarkably effective.
Elting
Jan Willem
JW
Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. j.w.j.elting@neuro.umcg.nl
Naalt
Joukje van der
Jv
Fock
Johanna Maria
JM
D000927:Anticonvulsants / Q000627:therapeutic use; D004569:Electroencephalography; D006801:Humans; D007036:Hypothermia, Induced; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications / Q000628:therapy*; D013226:Status Epilepticus / Q000209:etiology / Q000628:therapy*
D000927:Anticonvulsants