Table 1.
Clinical characteristics of patients
| Characteristics | Case 1 | Case 2 | Case 3 | Case 4 | Case 5 |
|---|---|---|---|---|---|
| Age (years) | 22 | 45 | 14 | 42 | 42 |
| Gender | Female | Female | Male | Female | Male |
| Past history of epilepsy | No | No | No | No | No |
| Etiology | AntiNMDAR encephalitis | Viral encephalitis | Viral encephalitis | Viral encephalitis | Viral encephalitis |
| The type of SE | GCSE | GCSE | GCSE | GCSE | GCSE |
| Primary therapy | |||||
| Antiepileptic drugs (dosage, mg) | Diazepam (40) Valproate (3540) | Diazepam (10) Phenobarbital (1300) | Diazepam (100) Phenobarbital (1875) | Diazepam (200) Phenobarbital (1800) | Diazepam (60) Phenobarbital (1900) |
| Duration (h) | 23 | 18 | 2 | 30 | 26 |
| Anesthetic therapy | |||||
| The type of RSE | GCSE | GCSE | NCSE | GCSE | NCSE |
| Anesthetic (s) | Midazolam | Midazolam | Midazolam and propofol | Midazolam | Midazolam or propofol |
| Hypothermia therapy | |||||
| Cooling method | External | External | External | Endovascular | External |
| Target temperature (°C) | 35 | 35 | 35 | 34.5 | 35 |
| Time to target temperature (h) | 10 | 3 | 8 | 8 | 11 |
| Time at target temperature (h) | 82 | 48 | 120 | 72 | 216 |
| Rewarming period (h) | 32 | 25 | 32 | 40 | 26 |
| Results | |||||
| Termination of clinical seizures | Yes | Yes | Yes | No | No |
| Termination of electrographic | Yes | Yes | No | Yes | No* |
| seizures | |||||
| Reduction of seizures | Yes | Yes | Yes | Yes | Yes |
| Seizures rebound after rewarming | No | No | No | No | No |
| Interictal EEG pattern before hypothermia | RFAB | PEDs | SWB | IEDs | PEDs |
| Interictal EEG pattern during | IEDs | SWB | SWB | SWB, Burst-suppression | PEDs |
| hypothermia | |||||
| Complication related to treatment | |||||
| Hypotension | Yes | Yes | Yes | Yes | Yes |
| Sinus bradycardia | Yes | No | No | No | No |
| Pneumonia | Yes | No | Yes | No | Yes |
| Gastrointestinal paralysis† | Yes | Yes | Yes | Yes | Yes |
| Increase of amylase and lipase | Yes | Yes | No | No | No |
| Disturbance of coagulation | No | No | No | No | Yes‡ |
| Hypophosphatemia | Yes | No | No | No | No |
| Hyperglycemia | No | No | No | No | Yes |
| Deep venous thrombosis | No | No | No | No | Yes |
| Prognosis | |||||
| Length of NICU stays (d) | 49 | 15 | 95 | 44 | 39 |
| Length of hospital stays (d) | 102 | 15 | 95 | 44 | 39 |
| Discharge from the NICU | |||||
| Outcome | Survival | Survival | Survival | Survival | Survival |
| GOS score | 3 | 2 | 2 | 3 | 3 |
| EEG pattern | SWB | SWB | SWB | RFAB | Normal |
| Three months follow-up | |||||
| Outcome | Survival | Death | Survival | Survival | Survival |
| GOS score | 5 | 1 | 2 | 3 | 5 |
| Post-SE symptomatic epilepsy | No | No | Partial seizures at left corner of mouth | No | No |
*Control of generalized seizures except for periodic seizures; †Gastric retention >200 ml; ‡Prolonged prothrombin time and activated partial thromboplastin time. SE: Status epilepticus; GCSE: Generalized convulsive status epilepticus; NCSE: Nonconvulsive status epilepticus; RFAB: Rhythmic fast activities background; PEDs: Periodic epileptic discharges; SWB: Slow wave background; IEDs: Interictal epileptiform discharges; NMDAR: N-methyl-D-aspartate receptor; RSE: Refractory status epilepticus; EEG: Electroencephalogram; NICU: Neurological Intensive Care Unit; GOS: Glasgow Outcome Scale.