Minocycline in chronic management of febrile infection-related epilepsy syndrome (FIRES): a case series and literature review of treatment strategies

The effectiveness of treatment for the chronic phase of febrile infection-related epilepsy syndrome (FIRES) remains uncertain. This study aimed to evaluate the therapeutic efficacy of minocycline in patients with chronic FIRES who had a poor response to conventional antiseizure medications. Three patients received 100 mg of minocycline (100 mg twice daily for 12 weeks), with effectiveness assessed based on seizure frequency, duration, type, and quality of life (using the quality of life in epilepsy-31, QOLIE-31), alongside adverse event monitoring. Results showed that one patient (Patient 3) exhibited a significant reduction in seizure duration and improved QOLIE-31 scores, with focal seizures being the only type observed after treatment. However, there was no statistically significant change in overall seizure frequency among the three patients. Additionally, a short literature review was conducted to explore various management strategies for chronic FIRES, including IL-1 receptor antagonist (anakinra) and IL-6 receptor antagonist (tocilizumab), centro-median thalamic nuclei deep brain stimulation, cannabidiol, responsive neurostimulation, intrathecal dexamethasone, ketogenic diet, and vagus nerve stimulation. In conclusion, considering the existing research on the etiological mechanisms of FIRES and based on our preliminary findings on the anti-inflammatory and antiepileptic properties of minocycline, early initiation of minocycline therapy in the chronic phase of FIRES should be explored further.Trial registrationClinicaltrials.gov (NCT05958069, retrospectively registered 22 July 2023).