[P3-55] Multimodal Approach in the Treatment of Febrile Infection-Related Epilepsy Syndrome with High Dose Phenobarbitone, Therapeutic Hypothermia and Perampanel
[Objective]: To report the favourable outcome of two children with febrile infection-related epilepsy syndrome (FIRES) treated with combination of high dose phenobarbitone, therapeutic hypothermia and perampanel (multimodal approach). [Method]: Clinical outcomes of these two children with FIRES who were treated with the above approach at our hospital were compared to our historical cohort of eleven children who were treated predominantly with high dose phenobarbitone and ketogenic diet. Their seizure control was determined at 3 months and long-term outcome was assessed using Glasgow Outcome Scale-Extended Pediatric Version (GOS-E Peds) and Modified Rankins Score. [Result]: The mean age at presentation of the 13 children with FIRES was 5.5 years old. All of them had normal neuroimaging, CSF findings and immunological workup. All had refractory status epilepticus and were treated unsuccessfully with multiple antiepileptic drugs. Both the patients who received the multimodal approach were treated with high dose phenobarbitone and therapeutic hypothermia for 5 days with good response. However, their seizures recurred following rewarming and only achieved sustained seizure control following addition of perampanel. At 3 months, both the cases who received the multimodal approach were seizure-free. In contrast, only 2 were seizure-free and 2 passed away in our historical cohort. Both children who received the multimodal approach but only 2 out of 11 of our historical cohort had favourable outcome on GOS-E Peds and Modified Rankins scores. [Conclusion]: This multimodal approach with high dose phenobarbitone, therapeutic hypothermia and perampanel appears to be safe, effective and confers a favourable long term outcome.