Both PTE and status epilepticus are associated with neuroinflammation and oxidative stress. Recent evidence demonstrates a therapeutic role of anti-inflammatory agents such as anakinra, a recombinant human IL-1 receptor antagonist, in patients with febrile-infection associated epilepsy syndrome. However, the safety and potential utility of anakinra in other pro-inflammatory epileptic conditions remains uncharacterized.

The patient is a 35-year-old right-handed male with a history of traumatic subdural hematoma status post evacuation, focal aware seizures and a previous episode of focal status epilepticus 1-year prior requiring intubation. On admission, he was on 4 anti-seizure medications (ASM) and presented with aphasia and continuous right hand and foot twitching. CT head confirmed prior left frontoparietal craniotomy and stable encephalomalacia along the left middle temporal gyrus.

Initial EEG showed disorganized background, absent posterior dominant rhythm with mild generalized slowing and left hemispheric slowing alongside 1-2 Hz LPD+F in the left hemisphere. His continuous right hand and foot twitching time locked to the LPDs, consistent with EPC.

Anakinra was initiated at 70mg IV day 1 and uptitrated to 100mg (1.24 mg/kg) q24hs day 2. His previous ASM were continued (levitiracetam, lacosamide, phenytoin, phenobarbital). Day 2, Clobazam 20mg q12hs was added. Day 3, the patient’s phenobarbital and phenytoin doses were increased and anakinra continued. On this day, 3 electrographic seizures were observed. Day 4, the patient began to return to baseline with resolution of motor twitching, improvement in speech, and EEG suppression. Day 5, anakinra was discontinued and he was discharged on 5 ASM with intact mental status and improved speech.

Anakinra was safe and well tolerated in this patient with EPC. While it cannot be determined if anakinra was efficacious in helping to treat this patient’s focal status, he did not require intubation, unlike his previous, similar admission 1-year prior.