Can fever treat epileptic encephalopathies?

SummaryPurposeTo describe resistant epileptic encephalopathies that significantly improved after an acute febrile episode (FE).MethodsWe reviewed the clinical history of patients with daily pharmacoresistant seizures referred to the Saint-Vincent de Paul Hospital in the last 5 years. Four patients experienced seizure arrest in relation with a febrile episode.ResultsThe four patients suffered from epileptic encephalopathy. Three were symptomatic, one cryptogenic. They presented spasms and atypical absences, beginning after the age of 1 year. All seizures stopped at the onset of fever, and significant EEG improvement was observed. The seizure-free period ranged from 2 to 24 months.Discussion and conclusionThe close link between the occurrence of FE and the disappearance of seizures and EEG improvement, contrasting with the previous pharmacoresistance of this epileptic encephalopathy, supports a non fortuitous association. Several mechanisms could explain this phenomenon, including viral etiology, hyperthermia, inflammatory-immune reaction and ACTH release. Better understanding this phenomenon could open new therapeutic perspectives.