Limbic and new onset refractory tonic status epilepticus (NORSE) in anti-NMDAR encephalitis

Abstract

Aims: To present a case of anti-NMDA receptor encephalitis (anti-NMDAR) with new onset refractory non-convulsive status epilepticus (NORSE). Methods: Case report with clinical details, MRI, PET, and EEG illustrations. Results: New onset refractory status epilepticus (NORSE) may arise from anti-NMDAR, and offers diagnostic and treatment challenges for immuno-therapy and refractory status epilepticus. Non-convulsive status epilepticus with generalized fast activity, has not been reported in anti-NMDAR, in NORSE. Conclusions: A patient with anti-NMDAR and generalized status with stiffening, right focal weakness, high frequency alpha/beta on EEG, brain FDG-PET/CT changes in the left temporo-parietal regions and cerebellum was presented. We discuss the unique treatment challenges of anti-NMDAR. NORSE and generalized nonconvulsive status epilepticus. Keywords: Tonic status epilepticus, Limbic encephalitis, Limbic status epilepticus, Anti-NMDAR, NORSE