New-onset refractory status epilepticus: A retrospective cohort study

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Abstract

Purpose: To describe the clinical, laboratory, neuroimaging, electroencephalographic features, etiology, treatment, as well as short-term and long-term outcomes of adults with new-onset refractory status epilepticus (NORSE). Method: A retrospective, single institution cohort study (2010–2018) of consecutive adult patients with NORSE. Results: Among 20 patients with NORSE, nine (45 %) had prodromal febrile illness, 12 (60 %) had evidence of inflammation on CSF profile. Six patients (30 %) met criteria for definite autoimmune encephalitis (AE) while 8 patients (40 %) had probable AE. Eleven out of 13 (85 %) patients had an abnormal FDG-PET scan with the most common finding being regional hypermetabolism. Fourteen patients (70 %) received immunotherapy and ten (50 %) received the ketogenic diet (KD). Fifteen patients (75 %) progressed to super-refractory status epilepticus (SRSE) and seven patients (35 %) died in the hospital or within six months of discharge. Among the surviving patients, eight (40 %) had a good outcome (i.e., modified Rankin Scale score 0–2); 12 (80 %) received a diagnosis of epilepsy of which nine (75 %) developed drug-resistant epilepsy. Conclusions: New-onset refractory status epilepticus is a syndrome associated with multiple complications, high mortality, and subsequent intractable epilepsy. There are multiple causes, some of which are autoimmune encephalitides; however, in this series the majority of patients had no clear etiology identified after extensive evaluation. Prospective studies are needed to determine optimal evaluation and treatment.

Original languageEnglish (US)
Pages (from-to)41-48
Number of pages8
JournalSeizure
Volume74
DOIs
StatePublished - Jan 2020

Keywords

  • Autoimmune encephalitis
  • FDG-PET
  • Ketogenic diet
  • New-onset refractory status epilepticus
  • Status epilepticus

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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