EXPLORING THE COMPLEXITIES OF FIRST-TIME REFRACTORY STATUS EPILEPTICUS (NORSE): A DIVERSE EXPERIENCE

Abstract

Objective: Refractory first-time status epilepticus (NORSE) poses a high risk of death and lasting neurological decline, even after extensive evaluations. The management of NORSE is an ongoing discussion among healthcare professionals. Strategies such as immunotherapies, early administration of intravenous anaesthetic treatments (IVAT), and rapid seizure cessation may help to reduce illness and death. We aimed to assess the critical care management of patients with NORSE, analysing patient demographics, clinical features, potential causes, treatment effectiveness, prognosis, and outcomes. We examined neuroimaging, lab investigations and the impact of timely interventions. Additionally, we compared NORSE to other forms of status epilepticus and highlighted the comprehensive evaluation and management challenges associated with this condition. Case summary: The study included three patients, all over 18 years of age, consisting of one male and two females. All patients had elevated body temperature, one reported a headache, and all had spontaneous epileptic seizures. Initial tests, including brain imaging, show normal results. However, two patients had bilateral hippocampal diffusion limitations, while one had hyperintense signals in the fossa. Cerebrospinal fluid (CSF) analysis revealed that two patients had 10 cells/l, and one had a higher count. Continuous monitoring of burst suppression patterns was performed while receiving IVAT. The typical duration of hospital stay was approximately 33.33 days, with a mean ICU stay of 28.66 days. Identified causes included a cryptogenic origin for two cases and a possible infectious aetiology for one.