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: Refractory status epilepticus (RSE) is seizure activity that persists despite acute administration of standard anticonvulsant therapy. It often occurs after cardiac arrest, indicating a poor prognosis. Therapeutic hypothermia (TH) reduces neurological injury in this patient population, and post cardiac arrest protocols now incorporate TH into the treatment algorithm. However, TH is not routinely used in RSE from other etiologies and little is known about the appropriate role of TH as an adjunct therapy. Methods: Five consecutive patients with RSE admitted to our neurocritical care unit treated with TH were retrospectively reviewed. Three patients had anoxic brain injury post cardiac arrest and two had epilepsy secondary to remote traumatic brain injury. All five patients received similar medical treatment for RSE. Results: The two post-traumatic epilepsy patients became seizure free with TH and remained seizure free after rewarming. Both had good neurological recovery and were discharged from rehabilitation back to baseline. Seizures persisted despite TH in the three postcardiac arrest patients and all three expired. Conclusion: Currently, there are only five reported cases of TH use in adult patients with status epilepticus. Our additional five cases suggest that RSE from etiologies other than anoxic brain injury post-cardiac arrest may have better outcomes with TH. The benefit of TH in RSE may depend on seizure etiology and may have a more favorable outcome in post-traumatic epilepsy patients.

Does the Benefit of Therapeutic Hypothermia in Refractory Status Epilepticus Depend on Seizure Etiology?