No added benefit with induced hypothermia for convulsive status epilepticus
medwireNews: Induced hypothermia as an adjunct to standard care fails to improve functional outcome after convulsive status epilepticus, HYBERNATUS study findings show.
Of 138 critically ill patients with convulsive status epilepticus randomly assigned to undergo induced hypothermia in addition to standard care, 49% had a Glasgow Outcome Scale (GOS) score of 5, representing no or minimal neurologic deficit, at 90 days. This was not significantly different to the 43% rate for the 130 patients assigned to standard care alone.
The distribution of GOS scores was also similar regardless of whether patients received hypothermia treatment.
For the whole group, epileptic drugs were initiated a median of 40 minutes after seizure onset, and electrical seizure activity was controlled in a median time of 80 minutes. For the hypothermia group, cooling began a median of 5.8 hours after seizure onset and the target temperature of 32–34 °C was reached in 98% of patients within a median of 5.2 hours.
The rate of progression to electroencephalographically confirmed status epilepticus was lower in the hypothermia group, at 11% versus 22%, otherwise all other secondary outcomes, including mortality at 90 days, did not differ significantly between the two groups.
More adverse events were reported in those undergoing hypothermia, mainly because of a higher rate of aspiration pneumonia and minor events, the team reports in TheNew England Journal of Medicine.
Stephane Legriel (Centre Hospitalier de Versailles–Site André Mignot, France) and co-workers conclude: “[T]his trial involving critically ill patients with convulsive status epilepticus who were receiving mechanical ventilation showed no significant benefit with respect to good functional outcome from the addition of therapeutic hypothermia to standard antiepileptic therapy.”
By Lucy Piper
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