Effect of vitamin administration on the prevention of acute encephalopathy with biphasic seizures and late reduced diffusion

This study examined whether encephalopathy vitamin therapy (EVT) with vitamins B1, B6, and carnitine, administered following febrile status epilepticus (FSE), could prevent acute encephalopathy with biphasic seizures and late reduced diffusion (AESD), improve neurological outcomes, and reduce pediatric intensive care unit (PICU) length of stay. We conducted a single-center retrospective cohort study comparing patients hospitalized with suspected post-FSE acute encephalopathy and treated with EVT (2016-2022) with a historical control group of patients who did not receive EVT (2009-2010). The primary endpoint was the incidence of AESD, and the secondary endpoints were a ≥2-point worsening in the Pediatric Cerebral Performance Category (PCPC) score at PICU discharge and a decrease in PICU length of stay. The AESD incidence did not differ significantly between 43 EVT cases and 14 controls (47 % vs. 57 %, p = 0.55), even with early EVT cases starting within 24 h of the inaugural seizure (43 % vs. 57 %, p = 0.53). EVT was associated with a lower rate of ≥2-point worsening in the PCPC score (23 % vs. 57 %, p = 0.025). Moreover, EVT was associated with significantly shorter PICU length of stay (median 7.0 vs. 13.5 days; p = 0.0012). EVT may mitigate acute neurological deterioration and shorten PICU length of stay; however, it has limited preventive efficacy against AESD, especially in severe cases.