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Febrile infection related epilepsy syndrome (FIRES) is a rare presentation of refractory status epilepticus with immune dysregulation as a potential pathologic mechanism. Despite promising results from second-line immunomodulators, approximately 30% remain refractory to treatment. We describe two children with FIRES who were unable to wean from anesthetic infusions with immunomodulatory treatment and subsequently received concurrent intrathecal dexamethasone and anakinra/tocilizumab as escalation of therapy. Following the initiation of this combined regimen, anesthetic infusions were decreased while maintaining seizure freedom. These cases demonstrate proof of principle that a multi-modal approach may be beneficial and should be considered in the treatment of FIRES.
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http://dx.doi.org/10.1002/acn3.70011 | DOI Listing |
Am J Obstet Gynecol
July 2025
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA.
Optimal neuraxial anesthesia for cesarean delivery requires a thorough understanding of patient, obstetrical, surgical, and anesthesia-related factors which can impact pain during and after cesarean delivery. While not all cesarean deliveries are the same from an obstetrical standpoint, not all anesthetics provide the same degree of anesthetic blockade and postcesarean analgesia; therefore, context is crucial to provide patients with a safe and pain-free experience. Communication between obstetrical and anesthesia teams is key to ensure that the anesthetic approach is tailored to the clinical scenario, particularly if emergency cesarean delivery is needed, and follows best practices for cesarean delivery anesthesia.
View Article and Find Full Text PDFNeurol Sci
August 2025
Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Ann Med Surg (Lond)
July 2025
Department of Obstetrics and Gynecology, School of Medicine, Kamali Hospital, Alborz University of Medical Sciences, Karaj, Iran.
Aim: The purpose of this study was to evaluate the effect of adding low-dose bupivacaine-dexamethasone for intrathecal labor analgesia in vaginal delivery.
Methods: This study was conducted as a clinical trial on full-term, singleton pregnant women aged between 20 and 40 years, who were candidates for natural childbirth and were in the second phase of the first stage of labor. Patients were randomly assigned to either the control group, which received only a single-shot intrathecal injection of 5 μg of sufentanil, or the intervention group, which, in addition to receiving spinal anesthesia with a single-shot intrathecal injection of 5 μg of sufentanil, also received an intrathecal injection of 5 mg of dexamethasone.
Cureus
July 2025
Department of Hematology, Lyndon B. Johnson Hospital, Houston, USA.
Central nervous system (CNS) involvement in adult B-cell acute lymphoblastic leukemia (B-ALL) continues to pose treatment challenges, even with advancements in chemotherapy and targeted immunotherapy. Blinatumomab, a bispecific T-cell engager, has been shown to improve outcomes for patients with relapsed or refractory B-ALL; however, it can lead to immune-related neurotoxic effects, including immune effector cell-associated neurotoxicity syndrome (ICANS). We present an unusual case of a 38-year-old man with refractory B-ALL who experienced a parenchymal CNS relapse that manifested as foot drop during treatment with blinatumomab, likely as a result of ICANS.
View Article and Find Full Text PDFCurr Opin Pediatr
August 2025
Division of Neurology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Purpose Of Review: New-onset refractory status epileptics (NORSE) and a subset, febrile infection-related epilepsy syndrome (FIRES), are rare clinical presentations with rapid onset, cryptogenic etiology, unpredictable course, and long-standing neurologic sequalae. International consensus recommendations were published in 2022 to aid in diagnosis, treatment, and research of NORSE/FIRES. Subsequently, there have been advances in understanding both the pathophysiology and the efficacy of immunotherapies.
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