Hypothermia in Status Epilepticus does not improve outcome

Stephane Legriel, M.D., Virginie Lemiale, M.D., Maleka Schenck, M.D et al published study in NEJM on Dec 22,2016  evaluating use of hypothermia in status epilepticus.

Therapeutic hypothermia does not improve outcome but can be a potential tool to treat seizures.

The HYBERNATUS (Hypothermia for Brain Enhancement Recovery by Neuroprotective and Anticonvulsant Action After Convulsive Status Epilepticus) trial was conducted in 11 French intensive care units (ICUs).

Total 268 adult patients (Eligible patients had convulsive status epilepticus, defined as 5 minutes or more of continuous clinical seizure activity or more than two seizures without a return to baseline in the interval and were receiving mechanical ventilation)

Core body temperature was lowered to 32 to 34°C in the treatment group.

There was no difference in primary outcome of 5 on the Glasgow Outcome Scale (GOS) between two groups.

Progression to EEG confirmed status was less in the hypothermia group pointing towards its use as anticonvulsant.

There was no difference in any other secondary outcomes of mortality, LOS etc.

 

Bottomline

Since the publication of the original two trials by Bernard et al and The Hypothermia after Cardiac Arrest Study Grouptherapeutic hypothermia has been tried as neuroprotective strategy in various clinical conditions.

Unfortunately, randomized trials have so far proven it to be not effective in subarachnoid hemorrhage surgery, stroke,  traumatic brain injury, bacterial meningitis,  extracorporeal cardiopulmonary resuscitation  and now status epilepticus.

Results from ongoing, prospective randomized-controlled trials are highly anticipated in intracerebral hemorrhage as well as non shockable out of hospital cardiac arrest.