scholarly journals Intravenous immunoglobulin response in new-onset refractory status epilepticus (NORSE) COVID-19 adult patients

2021 ◽  
Author(s):  
Paolo Manganotti ◽  
Giovanni Furlanis ◽  
Miloš Ajčević ◽  
Cristina Moras ◽  
Lucia Bonzi ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Intravenous Immunoglobulin ◽  
Case Series ◽  
Autoimmune Encephalitis ◽  
Refractory Status Epilepticus ◽  
Adult Patients ◽  
University Hospital ◽  
Paroxysmal Activity ◽  
Refractory Status ◽  
New Onset

AbstractNeurological manifestations may be common in COVID-19 patients. They may include several syndromes, such as a suggested autoimmune abnormal response, which may result in encephalitis and new-onset refractory status epilepticus (NORSE). Quickly recognizing such cases and starting the most appropriate therapy is mandatory due to the related rapid worsening and bad outcomes. This case series describes two adult patients admitted to the university hospital and positive to novel coronavirus 2019 (SARS-CoV-2) infection who developed drug-resistant status epilepticus. Both patients underwent early electroencephalography (EEG) assessment, which showed a pathological EEG pattern characterized by general slowing, rhythmic activity and continuous epileptic paroxysmal activity. A suspected autoimmune etiology, potentially triggered by SARS-CoV-2 infection, encouraged a rapid work-up for a possible autoimmune encephalitis diagnosis. Therapeutic approach included the administration of 0.4 g/kg intravenous immunoglobulin, which resulted in a complete resolution of seizures after 5 and after 10 days, respectively, without adverse effects and followed by a normalization of the EEG patterns.

scholarly journals New-onset super refractory status epilepticus: A case-series

Seizure ◽  
2020 ◽  
Vol 75 ◽  
pp. 174-184 ◽  
Author(s):  
Sidra Aurangzeb ◽  
Lara Prisco ◽  
Jane Adcock ◽  
Mahiri Speirs ◽  
Simon Raby ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Refractory Status ◽  
New Onset

scholarly journals New-onset super-refractory status epilepticus

Neurology ◽  
2020 ◽  
Vol 95 (16) ◽  
pp. e2280-e2285 ◽  
Author(s):  
Elizabeth Matthews ◽  
Ayham Alkhachroum ◽  
Nina Massad ◽  
Riva Letchinger ◽  
Kevin Doyle ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Medical Center ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Hospital Length Of Stay ◽  
Post Discharge ◽  
Refractory Status ◽  
New Onset

ObjectiveTo better understand the heterogeneous population of patients with new-onset refractory status epilepticus (NORSE), we studied the most severe cases in patients who presented with new-onset super-refractory status epilepticus (NOSRSE).MethodsWe report a retrospective case series of 26 adults admitted to the Columbia University Irving Medical Center neurologic intensive care unit (NICU) from February 2009 to February 2016 with NOSRSE. We evaluated demographics, diagnostic studies, and treatment course. Outcomes were modified Rankin Scale score (mRS) at hospital discharge and most recent follow-up visit (minimum of 2 months post discharge), NICU and hospital length of stay, and long-term antiepileptic drug use.ResultsOf the 252 patients with refractory status epilepticus, 27/252 had NORSE and 26/27 of those had NOSRSE. Age was bimodally distributed with peaks at 27 and 63 years. The majority (96%) had an infectious or psychiatric prodrome. Etiology was cryptogenic in 73%, autoimmune in 19%, and infectious in 8%. Seven patients (27%) underwent brain biopsy, autopsy, or both; 3 (12%) were diagnostic (herpes simplex encephalitis, candida encephalitis, and acute demyelinating encephalomyelitis). On discharge, 6 patients (23%) had good or fair outcome (mRS 0–3). Of the patients with long-term follow-up data (median 9 months, interquartile range 2–22 months), 12 patients (71%) had mRS 0–3.ConclusionAmong our cohort, nearly all patients with NORSE had NOSRSE. The majority were cryptogenic with few antibody-positive cases identified. Neuropathology was diagnostic in 12% of cases. Although only 23% of patients had good or fair outcome on discharge, 71% met these criteria at follow-up.

The timelines of MRI findings related to outcomes in adult patients with new‐onset refractory status epilepticus

Epilepsia ◽  
2020 ◽  
Vol 61 (8) ◽  
pp. 1735-1748
Author(s):  
Hyo Jae Kim ◽  
Sang‐Ahm Lee ◽  
Hyun‐Woo Kim ◽  
Soo Jeong Kim ◽  
Sang‐Beom Jeon ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Adult Patients ◽  
Mri Findings ◽  
Refractory Status ◽  
New Onset

scholarly journals New Onset Refractory Status Epilepticus as an Unusual Presentation of a Suspected Organophosphate Poisoning

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Shahan Waheed ◽  
Amber Sabeen ◽  
Nadeem Ullah Khan
Keyword(s):  
Status Epilepticus ◽  
Intravenous Infusion ◽  
Refractory Status Epilepticus ◽  
Young Female ◽  
University Hospital ◽  
Organophosphate Poisoning ◽  
Anesthetic Agents ◽  
Refractory Status ◽  
History Of ◽  
New Onset

New onset refractory status epilepticus (NORSE) is a new entity in medical literature. It has different infectious and noninfectious etiologies showing a devastating impact onto the clinical outcome of patients. Therapy with anaesthetic and antiepileptic agents often fails to improve the condition, unless the primary cause is rectified. Here is presented the case of a young female with a history of depression who after a recent bereavement came to the Emergency Department of Aga Khan University Hospital with complaints of drowsiness that lasted for few hours. Though she had no history of organophosphate poisoning, her physical examination and further investigations were suggestive of the diagnosis. During her hospital stay, she developed refractory status epilepticus. Her seizures did not respond to standard antiepileptic and intravenous anesthetic agents and subsided only after intravenous infusion of atropine for a few days. Organophosphate poisoning is a very common presentation in the developing world and the associated status epilepticus poses a devastating problem for emergency physicians. In patients with suspected organophosphate poisoning with favoring clinical exam findings, the continuation of atropine intravenous infusion can be a safe option to abate seizures.

scholarly journals New-onset refractory status epilepticus (NORSE) in post SARS-CoV-2 autoimmune encephalitis: a case report

2020 ◽  
Author(s):  
Fedele Dono ◽  
Claudia Carrarini ◽  
Mirella Russo ◽  
Maria Vittoria De Angelis ◽  
Francesca Anzellotti ◽  
...  
Keyword(s):  
Case Report ◽  
Status Epilepticus ◽  
Autoimmune Encephalitis ◽  
Refractory Status Epilepticus ◽  
Refractory Status ◽  
New Onset

scholarly journals How to Help Your Patients Enroll in the New-Onset Refractory Status Epilepticus (NORSE) and Febrile Infection-Related Epilepsy Syndrome (FIRES) Family Registry, and Other Rare Epilepsy Registries

2021 ◽  
pp. 153575972199832
Author(s):  
Karnig Kazazian ◽  
Marissa Kellogg ◽  
Nora Wong ◽  
Krista Eschbach ◽  
Raquel Farias Moeller ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Epilepsy Syndrome ◽  
Neurologic Disorder ◽  
Mortality And Morbidity ◽  
Refractory Status ◽  
Rigorous Research ◽  
Active Epilepsy ◽  
New Onset

New-onset refractory status epilepticus (NORSE) is a rare clinical presentation of refractory status epilepticus (RSE) that occurs in people without active epilepsy or preexisting neurologic disorder. Febrile infection-related epilepsy syndrome (FIRES) is a subcategory of NORSE. New-onset refractory status epilepticus/FIRES are becoming increasingly recognized; however, information pertaining to disease course, clinical outcomes, and survivorship remains limited, and mortality and morbidity are variable, but often high. The objective of the NORSE/FIRES Family Registry is to (1) provide an easily accessible and internationally available multilingual registry into which survivors or NORSE/FIRES surrogates or family members of people affected by NORSE/FIRES or their physicians can enter data in a systematic and rigorous research study from anywhere in the world where internet is available; and (2) to examine past medical history, outcomes, and quality of life for people affected by NORSE/FIRES.

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