The New-Onset Refractory Status Epilepticus (NORSE) is a rare entity that is defined as a clinical presentation, in a patient without active epilepsy or other relevant neurological disorder, who presents a refractory status epilepticus (RSE) without an acute or active structural, toxic, or metabolic cause. NORSE constitutes a diagnostic challenge that implies high morbidity and mortality in the short and long term. Clinically, NORSE is characterized by a prodromal phase, an acute phase, where seizures with diverse semiology that evolve to an RSE occur, and a chronic phase, with neurological deterioration and drug-resistant epilepsy. After an extensive work-up, the cause of NORSE is identified in only half of the cases. The initial treatment is based on the use of conventional anti-seizure drugs, requiring most of patients the use of anesthetics and mechanical ventilation. Better results have been observed with immunotherapy, more recently with anti-cytokine drugs, such as tocilizumab and anakinra, consistent with the immunological/inflammatory mechanisms proposed for the pathophysiology of NORSE.
estado epiléptico
Discapacidad asociada a manifestaciones neurológicas de COVID-19. Disability associated with COVID-19’s neurological manifestations
Introduction: COVID-19 is mainly a respiratory illness, however, with an incidence in nearly a third of patients of neurological manifestations secondary to affection to the central or peripheral nervous system, used to be more frequent in severe illness, having a wide range of disability and mortality.
Clinical case: We present the clinical case of a 39 years old female ,previously healthy, with diagnosis of COVID-19, initiating her illness with encephalitis and status epilepticus, posteriorly longitudinally extensive myelitis and anoxic-ischemic encephalopathy, which, despite of opportune diagnosis and treatment, she had a poor outcome developing persistent vegetative state.
Conclusions: COVID-19’s neurological manifestations could lead to a high risk of disability and mortality, needing an opportune detection and treatment, with a high suspicion of encephalitis and status epilepticus in patients with decrease of alertness and focal motor symptoms.
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Epilepsia Como Factor Pronóstico de Refractariedad y Funcionalidad en Estado Epiléptico en Pacientes Mexicanos. Epilepsy As Prognostic Factor Of Refractoriness And Functionality In Status Epilepticus In Mexican Patients.
Introduction: Status epilepticus is a medical condition which could lead to a great disability and be mortal. Background of epilepsy could prevent a progression to a refractory status epilepticus and predict a good functional prognosis. Nevertheless, in Mexican population there are no studies about that.
Materials and methods: An observational, analytic, retrospective, cohort study was performed with patients with status epilepticus in Specialities Hospital of “Siglo XXI” National Medical Center, in Mexico. It was evaluated the probability of presenting refractory status epilepticus and a good functional outcome in patients with a background of epilepsy, performing Pearson Chi-square.
Results: 40 patients with status epilepticus were included, 32 with refractory status epilepticus and 14 with a background of epilepsy. The probability of presenting a refractory status epilepticus with a background of epilepsy was OR 1.29 (p 0.53), and for a good functional outcome was OR 3.63 (p 0.10).
Conclusions: Background of epilepsy is not a protective factor for preventing the progression to a refractory status epilepticus, neither a factor for predicting a good functional outcome in our study with Mexican population. Nevertheless, further studies with a bigger sample are needed in order to prove these results.
