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Plasma exchange in cryptogenic new onset refractory status epilepticus
Judy Li1, Christina Saldivar, Rama K Maganti
1Barrow Neurological Institute, Phoenix, AZ, United States. jli1@phoenixchildrens.com
Seizure
|October 17, 2012
Summary
New onset refractory status epilepticus (NORSE) is challenging to treat. Plasma exchange therapy effectively stopped seizures in three patients, suggesting its early use for better outcomes.
Area of Science:
- Neurology
- Critical Care Medicine
Background:
- New onset refractory status epilepticus (NORSE) presents a significant therapeutic challenge due to its often cryptogenic nature.
- Standard treatments involving anticonvulsants and anesthetics may be ineffective for prolonged periods.
Observation:
- Three patients with NORSE, refractory to conventional treatments for over five days, underwent extensive diagnostic evaluations.
- These evaluations included advanced neuroimaging (MRI), cerebrospinal fluid analysis, malignancy screening, and serological testing for infectious and autoimmune causes.
Findings:
- All three patients demonstrated a dramatic response to plasma exchange therapy, achieving cessation of status epilepticus within four days.
- Despite comprehensive investigations, the underlying etiology for NORSE remained unidentified in these cases.
Implications:
- Early implementation of plasma exchange therapy for NORSE is proposed, supported by Class IV evidence.
- This approach may help prevent severe complications associated with prolonged status epilepticus and reduce hospitalization duration.
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