Effects of steroids on super-refractory status epilepticus in tick-borne meningoencephalitis

We report a unique case of super-refractory status epilepticus (SRSE) secondary to tick-borne encephalitis (TBE) to evaluate the therapeutic challenges and potential benefits of steroid treatment in this context. A previously healthy 31-year-old woman was admitted to the hospital with fever, headache, vertigo, and meningismus, ultimately diagnosed with TBE. Despite empirical antimicrobial treatment, the patient's condition deteriorated, leading to coma and SRSE. Various antiseizure medications and sedatives were administered without sustained success. Steroid treatment was initiated due to elevated intracranial pressure and persistent seizure activity. Following the administration of dexamethasone, electrographic status epilepticus resolved, though the patient developed clinical signs of increased intracranial pressure necessitating decompressive craniectomy. The patient's condition stabilized with a combination of antiseizure medicazions. Despite cessation of SRSE, the patient remained in a minimally conscious state at discharge, showing only gradual improvement over time. The use of steroids in TBE is controversial, with limited reports of potential benefits. In this case, steroid administration coincided with the cessation of SRSE, and authors explore its potential benefit considering its immunomodulatory effects.