585 - Effectiveness of Vitamins B1 and B6 and L-carnitine for Preventing Acute Encephalopathy with Febrile Convulsive Status Epilepticus and Improving Neurological Outcomes

Publication Number: 3566.585

Sachiho Saito, Tokyo Metropolitan Children's Medical Center, Kunitachi-shi, Tokyo, Japan; Toshiki Nakamura, Tokyo metropolitan children’s medical center, Fuchu city, Tokyo, Japan; Nanako Kawata, Tokyo Metropolitan Children's Medical Center, Fuchu city, Tokyo, Japan; Kento Ikegawa, Tokyo metropolitan children’s medical center, Fuchu, Tokyo, Japan; Funato Sato, Tokyo MetropolitanHospital Organization, Fuchu, Tokyo, Japan; Hiroshi Sakakibara, Tokyo Metropolitan Children's Medical Center, Fuchu-shi, Tokyo, Japan

Background: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is characterized by seizures with a biphasic course and impaired consciousness. It is the most prevalent form of acute encephalopathy among Japanese children. Recent reports have suggested that vitamin therapy may help prevent AESD onset and improve neurological outcomes following febrile status epilepticus (FSE). However, these studies were limited by a small sample size and lack of adjustment for confounders.

Objective: This study aimed to evaluate the efficacy of vitamin therapy for preventing the onset of acute encephalopathy with febrile convulsive status epilepticus (AEFCSE) and improving the post-FSE neurological prognosis.

Design/Methods: Patients aged 15 years or less who had been admitted to Tokyo Metropolitan Children's Medical Center's intensive care unit for FSE lasting more than 30 minutes were included. The exclusion criteria were encephalopathy other than AEFCSE, cerebrovascular disorders, etc. A vitamin-therapy (VT) group receiving vitamin B1 10 mg/kg/day, vitamin B6 20 mg/kg/day, and L-carnitine 30 mg/kg/day within 72 hours of symptom onset were retrospectively compared with a non-vitamin therapy (NVT) group. A poor neurological outcome was defined as a discharge Pediatric Cerebral Performance Category (PCPC) score of 3 or higher in patients whose pre-admission PCPC score was 1, or as an increase of at least one point in the discharge PCPC score in patients whose pre-admission PCPC score was 2 or higher. Inverse probability weighting based on propensity scores was used for analysis. The covariates included the Tada score, age, pathogen, seizure duration, EEG abnormalities, and history of neurotoxicity disorders.

Results: Of 157 patients with FSE, 109 were included. Of these, 40 (37%) and 69 (63%) were classified into the VT group and NVT group, respectively. These groups did not differ in terms of patient background, seizure duration or examination findings. There were eight (20%) and 11 (16%) cases of AEFCSE in the VT group and the NVT group, respectively. However, in the propensity score analysis, the former were less likely to have AEFCSE (odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.20-2.39). Five (13%) and ten (14%) patients in the VT and NVT group, respectively, had a poor prognosis. An analysis using the same methodology indicated fewer patients with a poor prognosis in the VT group (OR: 0.66; 95% CI: 0.20-2.13).

Conclusion(s): Vitamin administration in patients with FSE may prevent the onset of AEFCSE and reduce the likelihood of early neurological deterioration.

Table 1. Characteristics of the patients in the vitamin therapy and non-vitamin therapy groups


Table 2. The effect of vitamin therapy on the onset of AEFCSE and neurological prognosis