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Pediatric new-onset super refractory status epilepticus: Potential of timely immunotherapy in a resource-limited PICU

Aakash Chandran Chidambaram1, Jerin C Sekhar1, Suresh Kumar Angurana1

  • 1Division of Pediatric Critical Care.

Seizure
|February 12, 2026
PubMed

Insights

Pediatric new-onset super-refractory status epilepticus (NOSRSE) can have favorable outcomes with early immunotherapy improving survival. Protocolized care is crucial, especially in resource-limited settings for these severe pediatric epilepsy cases.

Area of Science:

  • Pediatric Neurology
  • Critical Care Medicine
  • Epileptology

Background:

  • New-onset super-refractory status epilepticus (NOSRSE) is a severe neurological emergency in children.
  • Understanding its clinical profile, management, and outcomes is vital for improving patient care.

Purpose of the Study:

  • To describe the clinical characteristics, management strategies, and outcomes of pediatric NOSRSE.
  • To identify factors predicting survival in children with NOSRSE.

Main Methods:

  • Retrospective observational study of 36 children with NOSRSE in a Pediatric Intensive Care Unit.
  • Analysis of clinical data, neurodiagnostic findings, treatments, and outcomes.
  • Univariate logistic regression to determine survival predictors.

Main Results:

  • The median age was 8 years, with 63.9% males. Etiology remained unknown in 77.7% of cases.
  • MRI abnormalities and non-convulsive seizures on EEG were common (72.7% and 55.6%, respectively).
  • Seizure control was achieved in 80.6%, with a 72.2% survival rate. Early immunotherapy was linked to better survival (OR 0.83).

Conclusions:

  • Favorable outcomes are achievable in pediatric NOSRSE despite illness severity.
  • Early immunotherapy is associated with improved survival rates.
  • Time-sensitive, protocolized care is essential for pediatric NOSRSE, particularly in resource-limited environments.
Abstract

Keywords:
Febrile infection-related epilepsy syndrome (FIRES)ImmunotherapyIntensive care units, PediatricNew-onset refractory status epilepticus (NORSE)Status epilepticusStatus epilepticus, Super-refractory

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