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

## TL;DR

This study explores minocycline as a treatment for chronic FIRES, showing some improvement in seizure duration and quality of life in one patient.

## Contribution

Preliminary evidence suggests minocycline's potential as an early treatment for chronic FIRES due to its anti-inflammatory and antiepileptic properties.

## Key findings

- One patient showed reduced seizure duration and improved quality of life after minocycline treatment.
- No statistically significant change in overall seizure frequency was observed among the three patients.
- A literature review highlighted various treatment strategies for chronic FIRES, including anti-inflammatory drugs and neurostimulation.

## Abstract

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 registration

Clinicaltrials.gov (NCT05958069, retrospectively registered 22 July 2023).