Favorable clinical course after early-intensive immunotherapy for new-onset refractory status epilepticus

Abstract

Background New-onset refractory status epilepticus (NORSE) refers to the newly established concept of a disease characterized by refractory status epilepticus without an identifiable etiology. Recent reports have indicated the importance of immunotherapy for NORSE. Case Report A 37-year-old man with no past history of epilepsy was admitted for a presenting complaint of confusion. He was treated with acyclovir and anti-epileptic drug (AED) for presumed herpes encephalitis. However, he developed generalized tonic-clonic seizures on day 6 of admission that worsened despite treatment with multiple AEDs. NORSE was considered to be a probable diagnosis and immunotherapy with methylprednisolone and immunoglobulin was scheduled. However, persistent seizure activity was observed on the electroencephalogram after the completion of initial immunotherapy. Subsequently, rituximab was administered for 4 weeks. He eventually regained consciousness and was able to resume social activity. Conclusion Our patient exhibited a favorable outcome with early-intensive immunotherapy and subsequent rituximab treatment for NORSE.

Keywords

• new-onset refractory status epilepticus
• immunotherapy
• rituximab