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Pediatric Rehabilitation

Febrile Infection-related Epilepsy Syndrome (FIRES) with Encephalopathy: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 10

    Poster Presenter(s)

  • Ji Hyun Kim, Other

    Medical Student
    New York Medical College
    New York, New York

    • Co-Author(s)

  • Vera Tsetlina, MD

    Medical Director of Pediatric Physiatry, Maria Fareri Children’s Hospital
    New York Medical College, New York

Disclosure(s):
Ji Hyun Kim, Other: No financial relationships to disclose
Vera Tsetlina, MD: No financial relationships to disclose
Case Diagnosis: Febrile Infection-related Epilepsy Syndrome (FIRES) with encephalopathy.

Case Description or Program Description: A 7-year-old boy without past medical history presented with fever and altered mental status progressing to status epilepticus. He was diagnosed with Febrile Infection-related Epilepsy Syndrome (FIRES) leading to severe encephalopathy. He had a prolonged hospital course during which he was followed by our rehabilitation medicine team over 9 total months. His initial MRI of the brain was unremarkable, but subsequent imaging demonstrated progressive generalized parenchymal volume loss. His epilepsy required multiple medications and a Vagus Nerve Stimulation stimulator placement. Patient underwent tracheostomy and G-tube placement. His hospital course was further complicated by ileus requiring ileostomy with fistula. The patient showed severe neurological compromise with disorder of consciousness and fluctuating extensor rigidity in his legs and mild spasticity in the arms.

Setting: Tertiary care pediatric hospital.

Assessment/Results: Seizures are not fully controlled, but not daily. Patient has not experienced status epilepticus for at least 2 months. Throughout his hospitalization, he improved from coma to an unresponsive wakefulness state. The patient showed progressive functional recovery with first volitional arm movements observed 6 months post-diagnosis, improved neck control in 8 months, and consistent localization to pain and gaze toward familiar voices in 9 months post-diagnosis. At the time of discharge to a rehabilitation facility, he was tolerating sitting upright in a tilt in space chair and was actively moving bilateral arms, however unclear if purposefully.

Discussion (relevance): The pathophysiology of FIRES is unknown; it has been characterized by significant neurologic impairment and challenges to treatment. This case shows a similar pattern of disease progression in onset, but signifies slow but continuous neurological improvements in a patient with severe encephalopathy in FIRES.

Conclusions: Acute in-patient rehabilitation with skilled physical, occupational, and speech therapy and medical supervision is important in management of FIRES and enhancing functional recovery.