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

Abstract

Neurological 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.

Epilepsy as a Comorbidity in Polymyositis and Dermatomyositis—A Cross-Sectional Study

“…Of note, the recent COVID-19 pandemic uncovered possible therapeutic approaches for refractory epilepsy. This form of epilepsy developing secondary to COVID-19 is suggested to have an autoimmune etiology and a good response to intravenous immunoglobulin treatment was documented [36]. In terms of serum autoantibodies, we could not identify a statistically significant association between any of the common PM/DM autoantibodies and epilepsy in PM/DM patients.…”

Autoimmune encephalitis associated with COVID-19: A systematic review

“…However, antibody test could be negative in some patients ( Khoo et al, 2020 ). Studies have reported that corticosteroids and intravenous immunoglobulin are considered as first-line therapies for AE treatment ( Manganotti et al, 2021 , Khoo et al, 2020 , Pilotto et al, 2020 , Grimaldi et al, 2020 ).…”

Epilepsy as a Presenting Symptom of Covid-19 in a Tertiary Private Hospital in Northern Mexico

“…5 Two cases responding to intravenous immunoglobulin therapy, and one was associated with anti-NMDA encephalitis. 6,7,8 So far, there is no evidence that COVID-19 infection alone exacerbates seizures in patients with established epilepsy. However, a recent systematic review suggested that patients with pre-existing neurological disorders (including epilepsy) and COVID-19 may develop exacerbation of their neurological problems and also severe COVID-19.…”