Fighting FIRES with fire

Mirás Veiga A, Moreno DC, Menéndez AI, Siscart IM, Fernández MD, Sánchez EG,

González MG, Sáez FG. Effectiveness of Electroconvulsive Therapy for Refractory

Status Epilepticus in Febrile Infection-Related Epilepsy Syndrome.

Neuropediatrics. 2016 Jul 19. [Epub ahead of print]

Abstract

Febrile infection-related epilepsy syndrome (FIRES) is a rare condition which evolves into refractory status epilepticus (SE), with poor outcome in most cases. Conventional antiepileptic drugs fail to control SE in FIRES patients. We report the case of a previously healthy 4-year-old boy who was diagnosed with FIRES. One week after pharyngitis and high fever he started seizures, followed by refractory SE. Benzodiazepines, phenytoin, high-dose barbiturates that induce burst suppression, high doses of corticosteroids, plasmapheresis, immunoglobulins, propofol, lidocaine, ketamine, inhaled desflurane, ketogenic diet, lacosamide, and therapeutic hypothermia were tried at different times in a period of 8 weeks, but all of them were ineffective. Electroconvulsive therapy (ECT) has been used in refractory SE in children. We report a case in which ECT was successfully used for treatment of refractory SE in a pediatric patient with FIRES syndrome.