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.

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.

Nutritional intervention improves prognosis of subarachnoid hemorrhage patients undergoing aneurysmal clipping : a retrospective study.

Aneurysmal subarachnoid hemorrhage (SAH) is a serious clinical event associated with high mortality and, among survivors, serious morbidity. Maintaining the muscle volume in SAH patients is essential, as rehabilitation is often required after intensive care. In this study, we investigated whether proper nutritional administration improved clinical outcomes based on patients laboratory data and level of activities of daily living. This retrospective study was carried out on 250 consecutive SAH patients who underwent craniotomy within 72 hours of onset from February 2005 to June 2018. Finally, 75 patients with a BMI < 22 kg/m2 were included. We compared postoperative energy and protein intake in relation to measures of biochemical parameters and modified Rankin Scale at discharge. Serum Alb concentrations at 25-35 hospital days was significantly improved by postoperative energy intake of ≧25 kcal/kg and protein intake of ≧0.8 g/kg per day beginning 3 days. High serum Alb concentrations at 25-35 hospital days following the start of this intake were independent factors for good prognosis. This study suggests that the minimum postoperative nutritional intake per day for SAH patients undergoing aneurysmal clipping is 25 kcal/kg of energy and 0.8 g/kg of protein. Higher serum Alb concentrations corresponded to improved long-term functional outcome. J. Med. Invest. 70 : 226-230, February, 2023.

Nutritional Intervention Facilitates Food Intake after Epilepsy Surgery.

BACKGROUND: We investigated whether nutritional intervention affected food intake after epilepsy surgery and if intravenous infusions were required in patients with epilepsy. We hypothesized that postoperative food intake would be increased by nutritional intervention. The purpose of this study was to compare postoperative food intake in the periods before and after nutritional intervention. METHODS: Between September 2015 and October 2020, 124 epilepsy surgeries were performed. Of these, 65 patients who underwent subdural electrode placement followed by open cranial epilepsy surgery were studied. Postoperative total food intake, rate of maintenance of food intake, and total intravenous infusion were compared in the periods before and after nutritional intervention. RESULTS: A total of 26 females and 39 males (age range 3-60, mean 27.1, standard deviation (SD) 14.3, median 26 years) were enrolled. Of these, 18 females and 23 males (3-60, mean 28.2, SD 15.1, median 26 years) were in the pre-nutritional intervention period group, and eight females and 16 males (5-51, mean 25.2, SD 12.9, median 26.5 years) were in the post-nutritional intervention period group. The post-nutritional intervention period group showed significantly higher food intake (p = 0.015) and lower total infusion (p = 0.006) than the pre-nutritional intervention period group. CONCLUSION: The nutritional intervention increased food intake and also reduced the total amount of intravenous infusion. To identify the cut-off day to cease the intervention and to evaluate whether the intervention can reduce the complication rate, a multicenter study with a large number of patients is warranted.