Abstracts

Febrile seizures are the most common seizure type in childhood. In children with underlying epilepsy, febrile illnesses can provoke prolonged or recurrent seizures, including febrile status epilepticus. This risk is heightened in cases of febrile seizure plus (FS+) or genetic epilepsies exacerbated by fever. Given its immunomodulatory and anti-inflammatory effects, intravenous immunoglobulin (IVIG) has been proposed as a prophylactic intervention. However, clinical evidence supporting its efficacy remains limited.

We retrospectively reviewed medical records of four pediatric epilepsy patients with recurrent febrile seizures or febrile status epilepticus who received IVIG for prophylactic purposes. The cohort included one patient with Dravet syndrome, one with SCN8A-related epilepsy, one with a chromosomal microdeletion, and one with FS+. Clinical features, seizure frequency, duration of IVIG efficacy, epilepsy outcomes, antiepileptic drug use, neurodevelopmental assessments, EEG findings, and genetic test results were analyzed. The study was approved as IRB-exempt.

All four patients experienced their first febrile status epilepticus between 0.8 and 1 year of age and continued to have recurrent fever-induced seizures despite valproic acid treatment. IVIG was initiated at a mean age of 1.8 years, with 2–6 courses administered per patient. Each course provided approximately six months of seizure prophylaxis, and preemptive administration every 6–8 months effectively prevented febrile seizures. IVIG was discontinued by age 4–5 years, after which no effect on non-febrile seizures was observed. These clinical courses and treatment timelines are summarized in Figure 1.

MRI findings were normal in all patients. EEGs showed focal epileptiform discharges in three cases, improving over time except in the Dravet syndrome patient. Cognitive outcomes varied: the FS+ patient maintained normal development, while the others had intellectual disability. Non-febrile seizures were generally well controlled with 1–3 antiepileptic drugs, except in the Dravet patient.

This case-based analysis suggests a beneficial role of IVIG in reducing fever-associated seizure burden in pediatric epilepsy, particularly during the early years of life. The data call for future controlled studies to clarify its place in clinical management.