Neuropediatrics 2021; 52(02): 133-137
DOI: 10.1055/s-0040-1716903
Short Communication

Possible Role of High-Dose Barbiturates and Early Administration of Parenteral Ketogenic Diet for Reducing Development of Chronic Epilepsy in Febrile Infection-Related Epilepsy Syndrome: A Case Report

1  Department of Child Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
,
1  Department of Child Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
,
Koichi Ohsugi
2  Department of Emergency & Critical Care Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
,
Rika Suzumura
3  Division of Nutrition, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
,
Keiko Niimi
4  Division of Rehabilitation, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
,
Sayuri Shimizu
4  Division of Rehabilitation, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
,
Hiroshi Sakihama
5  Department of Pediatrics, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
,
Shinji Itamura
1  Department of Child Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
,
Keiko Hirano
6  Department of Pediatrics, Iwata City Hospital, Okubo, Iwata, Shizuoka, Japan
,
Mitsuyo Nishimura
7  Division of Clinical Laboratory, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
,
Ayataka Fujimoto
8  Department of Epilepsy and Surgery, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
,
Hideo Enoki
1  Department of Child Neurology, Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
› Author Affiliations

Abstract

We describe the efficacy of high-dose barbiturates and early administration of a parenteral ketogenic diet (KD) as initial treatments for acute status epilepticus (SE) in an 8-year-old girl with febrile infection-related epilepsy syndrome (FIRES). The patient was admitted to our hospital with refractory focal SE. Abundant epileptic discharges over the left frontal region were observed on electroencephalogram (EEG). Treatment with continuous infusion of thiamylal for 4 hours, increased incrementally to 40 mg/kg/h, successfully ended the clinical SE, and induced a burst-suppression coma. The infusion rate was then gradually decreased to 4 mg/kg/h over the next 12 hours. Parenteral KD was administered from days 6 to 21 of illness. Continuous infusion of thiamylal was switched to midazolam on day 10 without causing seizures or EEG exacerbations. The patient has remained seizure free in the 15 months since hospital discharge. The effectiveness of KD for the treatment of FIRES has attracted attention amongst clinicians, but KD treatment may need to last for 2 to 4 days before it can stop SE, a time period that could cause irreversible brain damage. Considering the severity of SE in our patient and the dose of barbiturates needed to treat it, we consider this case to have had a good clinical outcome. The results suggest that rapid termination of seizure using high-dose barbiturates in conjunction with early administration of parenteral KD could reduce the development of chronic epilepsy in patients with FIRES.

Ethics Statement

Written informed consent was obtained from the parents of the patient for the publication of this case report.


Financial Support

The authors declare that the research was conducted in the absence of any commercial or financial relationships.


Supplementary Material



Publication History

Received: 25 April 2020

Accepted: 28 July 2020

Publication Date:
23 November 2020 (online)

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