Intensive Intracranial Pressure and Temperature Monitoring May Improve the Outcome of a Young Patient with Severe Cryptogenic New-onset Refractory Status Epilepticus: A Case Report

Mayu Kambe ¹, Yuichi Kubota ¹, Hidenori Ohbushi ¹

⁰Department of Neurosurgery, Tokyo Women's Medical University - Adachi Medical Center, Tokyo, Japan.

Nmc Case Report Journal +

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November 3, 2025

View abstract on PubMed

Summary

New-onset refractory status epilepticus (NORSE) can be challenging. Intensive intracranial pressure management and thermoregulation significantly improved a young patient

Area Of Science

Neurology
Neurosurgery

Background

New-onset refractory status epilepticus (NORSE) is characterized by sudden, severe, and difficult-to-control seizures in young individuals without prior epilepsy history.
Neurosurgical interventions for NORSE are typically palliative or diagnostic.
This case highlights a potential therapeutic approach for NORSE.

Purpose Of The Study

To report a case of significant patient improvement following intensive intracranial pressure management for new-onset refractory status epilepticus.
To explore the role of neurosurgical interventions beyond palliation in NORSE.

Main Methods

A 20-year-old male with NORSE underwent percutaneous thermoregulation to 37°C to suppress electrographic seizures.
Intracranial pressure (ICP) monitoring and ventriculostomy were performed to manage elevated ICP.
Treatment involved a combination of medical management, thermoregulation, and ICP control.

Main Results

Thermoregulation partially suppressed electrographic seizures.
ICP management was initiated due to uncontrolled seizures.
The patient showed significant improvement in wakefulness (Glasgow Coma Scale from 3 to 8) and functional status (modified Rankin Score of 1) after 13 days of intensive management.
Seizure episodes ceased by day 22.

Conclusions

Intensive intracranial pressure management, alongside other interventions like thermoregulation, can lead to significant recovery in patients with new-onset refractory status epilepticus.
Neurosurgical interventions should be strongly considered in the management of NORSE, given its grave prognosis.
This case suggests that aggressive ICP management may offer a more substantial benefit than previously recognized in NORSE.

Keywords:

neurosurgery new-onset refractory status epilepticus seizure ventriculostomy