Causes and outcomes of new onset status epilepticus and predictors of refractoriness to therapy

New‐onset refractory status epilepticus (NORSE) and febrile infection–related epilepsy syndrome (FIRES): State of the art and perspectives

“…In a small but nonnegligible group of patients—mostly previously healthy young adults and children—an extensive diagnostic workup fails to reveal the cause of SE. This group may represent up to 60% of cases of de novo refractory SE . It is often misclassified as “possible encephalitis” in epidemiological studies, as diagnostic criteria for autoimmune and infectious encephalitis do not require the formal identification of the causative antibody or pathogen .…”

“…This group may represent up to 60% of cases of de novo refractory SE. 2,6 It is often misclassified as "possible encephalitis" in epidemiological studies, as diagnostic criteria for autoimmune and infectious encephalitis do not require the formal identification of the causative antibody or pathogen. 7,8 Prolonged seizure activity can cloud consciousness and alter cognition, and cause focal neurological deficits, as well transient magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) changes, [9][10][11] all carrying the risk of being mistaken for evidence of encephalitis.…”

Status Epilepticus in the Intensive Care Unit

“…Refractory SE is reported in 35 to 50% of the patients presenting with de novo SE within a hospital setting. 66,69 Refractory SE is defined as continuous SE that fails to respond to first-and second-line ASDs and often lasts over 30 minutes. Once a first-line ASD has failed to control seizures in the context of SE, a second ASD is less effective than the initial treatment and the third one is less effective than the first two.…”

“…70 Superrefractory SE (SRSE) is defined as SE that persists for over 24 hours, even after the administration of anesthetics. Retrospective reviews have shown the population with RSE to be younger than the one with non-RSE 69 and are more likely to have a nonidentified (cryptogenic) etiology. In fact, cryptogenic etiology is reported to be the most significant determinant for progression of new-onset SE to RSE and a higher mortality rate (40.4%).…”

“…In fact, cryptogenic etiology is reported to be the most significant determinant for progression of new-onset SE to RSE and a higher mortality rate (40.4%). 69 A review on outcome by Ferlisi and Shorvon including 596 patients with refractory CSE reported death in 35% of cases, severe neurologic deficit in 13%, milder deficits in 17%, and recovery to baseline in 35%. 66 The high risk of pharmacoresistance and neuronal injury associated with prolonged SE justifies the escalation of treatment to general anesthetics.…”