Abstracts

Rationale: Therapeutic hypothemia rarely has been applied as an adjunct to anticonvulsants in refractory convulsive status epilepticus treatment. However, in convulsive status epilepticus conditions, it is difficult to determine the pure effectiveness of hypothermia, due to unavoidable use of sedative drugs for maintaining the hypothermia management. In addition, the effectiveness of hypothermia has not been studies in refractory non-convulsive status epilepticus (NCSE). We report here successful use of therapeutic hypothermia without any sedative drugs in a case of medically refractory NCSE in a patient with temporal lobe epilepsy. . Methods: A 46-year-old man was referred to neurology part due to recurrent seizures attack. He was diagnosed with temporal lobe epilepsy 2 years ago, and had been taking valproic acid, levetiracetam, and vigabatrin. Electroencephalography (EEG), after first line status treatment by fosphenytoin loading, revealed continuous periodic discharges, consistent with NCSE. After NCSE diagnosis, pregabalin and phenobarbital were administrated with loading dose; however, there was no improvement of mental status and EEG abnormalities. At this time, simultaneously continuous EEG monitoring and therapeutic hypothermia was started. The Arctic Sun 5000?(R) temperature management system (external gel pads and circulating sterile water) was used for TH, with the induction phase lasting 8 h, and maintenance phase lasting 24 h at 35C; monitoring by esophageal core probes, and controlled rewarming over 8 h was performed to achieve normothermia. None of benzodiazepine class drugs that can affect the EEG improvement and recovery mental status were used for shivering control or hypothermia treatment maintenance. The treatment was continued by adding acetaminophen and buspirone (acetaminophen 2,600mg and buspirone 15mg per day) only. Results: Planned therapeutic hypothermia were completed without any problems. During hypothermia maintaining, EEG abnormalities were gradually improved and the patient's consciousness regained in proportion to the EEG improvement. Then, patient was alert on the second day after hypothermia application. Conclusions: This is the first report of successful treatment of medically refractory NCSE with therapeutic hypothermia. Because any sedative drugs were not used during hypothermia maintaining, the control of NCSE might be achieved by therapeutic hypothermia itself. Funding: No Funding