Neuromodulation in new-onset refractory status epilepticus

Area of Science:

• Neurology
• Neuroscience
• Critical Care Medicine

Background:

• New-onset refractory status epilepticus (NORSE) and Febrile infection-related epilepsy syndrome (FIRES) are severe neurological emergencies with high mortality and morbidity.
• Current treatments, including anesthetics and immune therapies, often yield suboptimal outcomes.
• There is a critical need for effective interventions to manage the acute phase of NORSE/FIRES.

Approach:

• A systematic review was conducted following PRISMA guidelines to evaluate neuromodulation techniques in acute NORSE/FIRES.
• The review analyzed 15 articles, encompassing 20 patient cases treated with various neuromodulation modalities.
• Included techniques were electroconvulsive therapy (ECT), vagal nerve stimulation (VNS), and deep brain stimulation (DBS).

Key Points:

• Neuromodulation was applied to 20 patients (13 FIRES, 17 cryptogenic NORSE), including 10 receiving ECT, 7 VNS, and 4 DBS.
• The patient cohort included 8 females and 9 children.
• Seventeen out of 20 patients experienced resolution of status epilepticus following neuromodulation therapy.

Conclusions:

• Neuromodulation techniques demonstrate potential clinical benefits in the acute management of NORSE/FIRES.
• Early consideration of neuromodulation may improve outcomes in these devastating conditions.
• Further research is warranted due to the limited sample size and heterogeneity of treatment protocols.