Evidence map›Paper›PMID 40279013›Full record

ArticleNeurocritical care2025

Intrathecal Dexamethasone as a FIRES Extinguisher: A 12-Patient Clinical Experience with Usage of Intrathecal Dexamethasone for Febrile Infection-Related Epilepsy Syndrome.

Raquel Farias-Moeller, Aurélie Hanin, Sadaf Ahsan, John Brooks, Scott D Caganap, Barry Czeisler, Emmanuel Cheuret, Brianna Cocuzzo, Cecil D Hahn, Henrik Kyureghyan and 7 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Neurocritical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Rapid recovery after intrathecal dexamethasone in FIRES.Epileptic disorders : international epilepsy journal with videotape · 2026
    Article
  3. ANA Investigates: NORSE and FIRES.Annals of neurology · 2026
    Article
  4. Breaking the neuroinflammatory loop with intrathecal dexamethasone in FIRES.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025
    Article
  5. Pathophysiology of Status Epilepticus Revisited.International journal of molecular sciences · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Raquel Farias-Moeller *Department of Neurology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
Aurélie Hanin *Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, CT, USA.
Sadaf AhsanDepartment of Paediatric Neurology, Nottingham University Hospitals, Nottingham, UK.
John BrooksThe Ottawa Hospital Civic Campus, Ottawa, ON, Canada.
Scott D CaganapProvidence Little Company of Mary Medical Center, Torrance, CA, USA.
Barry CzeislerProvidence Little Company of Mary Medical Center, Torrance, CA, USA.
Emmanuel CheuretUnité de Neuropédiatrie, Hôpital des enfants, Toulouse, France.
Brianna CocuzzoMaria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA.
Cecil D HahnDivision of Neurology, The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
Henrik KyureghyanWigmore Women's and Children's Hospital, Yerevan, Armenia.
Marie-Odile MarcouxRéanimation médico-chirurgicale néonatale et pédiatrique, Hôpital des enfants, 330 Avenue de Grande Bretagne, TSA 70034, 31059, Toulouse Cedex 9, France.
Rana MohamedDepartment of Paediatric Neurology, Nottingham University Hospitals, Nottingham, UK.
Carol ParkUniversity of Chicago, Chicago, IL, USA.
Michal Stern ZimmerDivision of Neurology, The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
Vivek BarunArtemis, Agrim Institute of Neuroscience Gurugram, Gurugram, Haryana, India.
Yi Chen LaiBaylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Lawrence J HirschDepartment of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, CT, USA. lawrence.hirsch@yale.edu.ORCID 0000-0002-6333-832X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNew-onset refractory status epilepticus (NORSE) is a devastating condition with high mortality and poor long-term outcomes. Febrile infection-related epilepsy syndrome (FIRES) is a subset of NORSE, preceded by fever. Intrathecal dexamethasone (IT-DEX) has emerged as a potential treatment, but few cases have been reported. This study aims to describe the use of IT-DEX in NORSE/FIRES, focusing on treatment logistics, dosing strategies, and patient outcomes.

methodsWe conducted a retrospective analysis of 12 patients (10 children and 2 adults) with NORSE (including FIRES) enrolled in an international multicenter clinical biorepository who received IT-DEX as part of their treatment. Demographic and clinical data were extracted. IT-DEX pharmacological details and administration logistics were collected by contacting the primary investigators. A descriptive analysis was performed to evaluate treatment timing, dosage, and concurrent management, as well as clinical outcomes and cytokine profiles.

resultsAll patients qualified as FIRES. Patients were treated with a median of five doses of IT-DEX, starting a median of 20 days after refractory status epilepticus onset, with a median dose per infusion of 5 mg (0.21 mg/kg/dose). Clinicians reported a perceived favorable effect on seizure control in 83% of cases, with a median delay of 5 days to wean off continuous infusions after the last IT-DEX administration. Cytokine analysis (based on data from four patients with serial cerebrospinal fluid measurements and two patients with serial blood measurements) revealed persistently elevated levels of proinflammatory markers in most patients, with no significant changes following IT-DEX administration. No adverse effects were reported.

conclusionsMost clinicians perceived a favorable effect of IT-DEX in refractory status epilepticus termination, and its use appears to be safe in patients with FIRES. This study provides a detailed description of administration logistics and dosing strategies from an international multicenter cohort. Additional studies are needed to confirm the safety and efficacy of IT-DEX and determine its impact on long-term outcomes including epilepsy prevention and functional recovery.

Indexed as

DexamethasoneDrug Resistant EpilepsyGlucocorticoidsStatus EpilepticusAdolescentAdultAgedChildChild, PreschoolFemaleFeverHumansInjections, SpinalMaleMiddle AgedRetrospective StudiesDexamethasoneGlucocorticoidsFebrile infection-related epilepsy syndromeIntrathecal dexamethasoneNew-onset refractory status epilepticusOutcomes

Identifiers

PMID40279013

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.