[P3-48] Immunotherapy for Children with Febrile Refractory Status Epilepticus
[Introduction]: Febrile infections are an important cause of pediatric refractory status epilepticus. Immune-mediated mechanisms and inflammation processes have been reported to determine or contribute to neurological manifestations in such patients. The aim of this study was to investigate the effects of intravenous immunoglobulin alone or in combination with methylprednisolone pulse therapy as adjuvant treatment for febrile refractory status epilepticus. [Methodology]: We retrospectively reviewed cases of febrile refractory status epilepticus in a pediatric intensive care unit between January 2000 and December 2013 and analyzed the clinical characteristics. [Results]: We enrolled 45 patients (27 boys), aged 1 to 18 years, all of whom received multiple antiepileptic drugs. Twenty-nine (64.4%) of the patients received intravenous immunoglobulin alone, and 16 (35.6%) received a combination of intravenous immunoglobulin and methylprednisolone pulse therapy as adjuvant treatment. Overall, 10 (22.2%) patients died within 1 month. After 2 years, three patients were lost to follow-up and nine (28.1%) had good neurological outcomes, including two who returned to baseline. We compared the outcomes of the patients who received intravenous immunoglobulin alone and those who received a combination of intravenous immunoglobulin and methylprednisolone pulse therapy. The latter group had better neurological outcomes at 2 years (p=0.048) and a shorter duration of hospitalization (p=0.016). [Conclusions]: Our results suggest that a combination of intravenous immunoglobulin and methylprednisolone pulse therapy as adjuvant treatment for febrile refractory status epilepticus may result in better neurological outcomes and shorter hospitalization. Further prospective studies are needed to confirm these findings.