Neurocritical Care

, 9:189 | Cite as

Hypothermia for Refractory Status Epilepticus

  • Jesse J. Corry
  • Rajat Dhar
  • Theresa Murphy
  • Michael N. Diringer
Original Article

Abstract

Introduction

Status epilepticus (SE) can be refractory to conventional anticonvulsants, requiring anesthetic doses of medications to suppress seizures. This approach carries significant morbidity, is associated with a high fatality rate, and may not always control SE. Hypothermia has been shown to suppress epileptiform activity experimentally, but has not previously been used as a primary modality to control SE in humans.

Methods

Four patients with SE refractory to benzodiazepine and/or barbiturate infusions were treated with hypothermia (target temperature: 31–35°C) using an endovascular cooling system. All received continuous EEG monitoring, three were on midazolam infusions and one had recurrent seizures on weaning from pentobarbital.

Results

Therapeutic hypothermia was successful in aborting seizure activity in all four patients, allowing midazolam infusions to be discontinued; three achieved a burst-suppression pattern on EEG. After controlled rewarming, two patients remained seizure-free, and all four demonstrated a marked reduction in seizure frequency. Adverse events included shivering, coagulopathy without bleeding, and venous thromboembolism. Two death occurred, neither directly related to hypothermia; however, immunosuppression related to the use of barbiturates and hypothermia may have contributed to an episode of fatal sepsis in one patient.

Conclusions

Hypothermia was able to suppress seizure activity in patients with SE refractory to traditional therapies with minimal morbidity. It appears promising as an alternative or an adjunct to anesthetic doses of other agents, but requires further study to better evaluate its safety and efficacy.

Keywords

Induced hypothermia Status epilepticus Endovascular cooling Barbiturates 

Notes

Acknowledgements

This work was financially supported by NIH NS35966.

Disclosure

MND consulted for Alsius Corporation several years ago.

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Copyright information

© Humana Press Inc. 2008

Authors and Affiliations

  • Jesse J. Corry
    • 1
    • 2
  • Rajat Dhar
    • 1
    • 2
  • Theresa Murphy
    • 1
    • 2
  • Michael N. Diringer
    • 1
    • 2
  1. 1.Department of Neurology, Neurology/Neurosurgery Intensive Care UnitWashington University School of MedicineSt. LouisUSA
  2. 2.Department of Neurological Surgery, Neurology/Neurosurgery Intensive Care UnitWashington University School of MedicineSt. LouisUSA

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