Abstract New-onset refractory status epilepticus (NORSE) is defined as a condition, not a specific diagnosis, with NORSE without a clear acute or active structural, toxic, or metabolic cause in a patient without active epilepsy. We herein report four cases of NORSE, of which three patients had preceding history of behavioral changes and psychiatric manifestations and one had history of preceding fever. All patients had abnormal electroencephalogram finding. Cerebrospinal fluid and serum examination was positive for anti-N-methyl D-aspartate receptor antibody. All cases received Intravenous pulse methylprednisolone, followed by plasmapheresis in two cases. In these two-patient seizure stopped, and they improved clinically. Two patients died due to ventilator associated pneumonia and sepsis. Our cases highlight that in patient presenting NORSE, preceding history of behavioral or psychiatric abnormality or confusion points toward autoimmune etiology. Early diagnosis and treatment prevent morbidity and mortality in these patients.
Ranjan et al. (Thu,) studied this question.