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Journal of Pediatric Neurology 2017; 15(06): 305-315
DOI: 10.1055/s-0037-1603594
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Intravenous Immunoglobulins for Refractory Status Epilepticus: A Scoping Systematic Review of the Pediatric Literature

F. A. Zeiler
1   Clinician Investigator Program, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
2   Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
3   Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
,
M. Matuszczak
3   Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
,
J. Teitelbaum
4   Department of Medicine, University of Manitoba, Winnipeg, Canada
,
C. J. Kazina
1   Clinician Investigator Program, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
,
L. M. Gillman
5   Section of Neurology, Montreal Neurological Institute, McGill, Montreal, Canada
6   Section of Critical Care Medicine, Department of Medicine, University of Manitoba, Winnipeg, Canada
7   Section of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Canada
› Author Affiliations
Further Information

Publication History

27 March 2017

27 April 2017

Publication Date:
02 June 2017 (online)

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Abstract

Our goal was to perform a scoping systematic review of the literature on the use of intravenous immunoglobulins (IVIGs) for refractory status epilepticus (RSE) in pediatric patients. Articles from MEDLINE, BIOSIS, EMBASE, Global Health, Healthstar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform, ClinicalTrials.gov (inception to June 2016), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and Grading of Recommendation Assessment Development and Education (GRADE) methodology by two independent reviewers. We identified 21 original articles. Eighty-seven pediatric patients were described as having received IVIG therapy for RSE. The mean age was 7.8 years (range: 2–17.5 years). Seizure response occurred in 14 of the 87 patients (16.1%), with 3 (3.4%) and 11 (12.6%) displaying partial and complete responses, respectively. Seventy-three of the 87 patients (83.9%) failed to display any seizure response to IVIG therapy. No complications related to IVIG therapy were recorded. The majority of patients had moderate to severe neurological deficits upon follow-up. Oxford level 4, GRADE D evidence exists to suggest little to no impact on seizure control in pediatric autoimmune RSE. Routine use of IVIG for pediatric RSE cannot be recommended at this time and should be considered experimental.

Keywords

intravenous immunoglobulins - immunoglobulin - pediatric - children - status epilepticus - refractory status epilepticus

Note

This study was conducted at the University of Manitoba. F.A,Z. has received salary support for dedicated research time, during which this project was partially completed. Such salary support came from the Royal College of Surgeons of Canada–Harry S. Morton Travelling Fellowship in Surgery, the University of Manitoba Clinician Investigator Program, R. Samuel McLaughlin Research and Education Award, the Manitoba Medical Service Foundation, and the University of Manitoba, Faculty of Medicine Dean's Fellowship Fund.


Funding

None.


Supplementary Material

 

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