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Clinical outcomes of cryptogenic new onset refractory status epilepticus (NORSE) in a tertiary hospital in Singapore: a case series.

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Title: Clinical outcomes of cryptogenic new onset refractory status epilepticus (NORSE) in a tertiary hospital in Singapore: a case series.
Authors: Goh, Yihui (AUTHOR), Chua, Christopher Yan Kit (AUTHOR), Lee, Tiffany Li Jia (AUTHOR), Soon, Derek (AUTHOR), Chong, Yao Feng (AUTHOR), Rathakrishnan, Rahul (AUTHOR)
Source: Neurological Sciences. Jun2025, Vol. 46 Issue 6, p2801-2807. 7p.
Subjects: Neurological emergencies, Status epilepticus, Anticonvulsants, Medical sciences, Treatment effectiveness
Abstract: Background: New Onset Refractory Status Epilepticus (NORSE) is a neurological emergency with high mortality. Cryptogenic NORSE (cNORSE) is defined by a lack of an identifiable structural, toxic or metabolic etiology despite extensive workup. Survivors often develop significant long-term neurological sequelae and drug-resistant epilepsy. However, studies have shown that despite prolonged hospitalization, a significant proportion of cNORSE patients can achieve favourable functional outcomes. Methods: A retrospective review of adult cNORSE patients between July 2019 and July 2023 in a tertiary hospital in Singapore was performed. Results: Thirteen patients with cNORSE were identified. Median age at presentation was 32.2 [IQR: 23.9–44.1] years and 6 (46.2%) of the patients were male. Eight (61.5%) patients fulfilled criteria for Febrile Infection-Related Epilepsy Syndrome (FIRES). Eight (61.5%) patients had abnormal index brain MRIs. The median duration of ICU stay was 37.0 [22.8–41.5] days. The total number of anti-seizure medications (ASMs) and anesthetics used was 6 [5–7] and 3 [2–4] respectively. All patients received immunotherapy and the time to immunotherapy initiation from SE onset was 2 [1–3] days. 4 (30.8%) patients demised during inpatient stay. Of 9 surviving patients, the median MRS on discharge was 4 [3–5]. MRS at 3 month and 1 year follow ups was 2 [1–5] and 1.0 [0.8-5.0] respectively. Conclusions: This retrospective study characterizes a cryptogenic NORSE cohort in a tertiary hospital in Singapore. Cryptogenic NORSE is associated with significant morbidity and mortality; however, long term outcomes may still be favourable in patients with initially severe illness and protracted ICU stay. [ABSTRACT FROM AUTHOR]
Copyright of Neurological Sciences is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Clinical outcomes of cryptogenic new onset refractory status epilepticus (NORSE) in a tertiary hospital in Singapore: a case series.
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  Data: <searchLink fieldCode="JN" term="%22Neurological+Sciences%22">Neurological Sciences</searchLink>. Jun2025, Vol. 46 Issue 6, p2801-2807. 7p.
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  Data: <searchLink fieldCode="DE" term="%22Neurological+emergencies%22">Neurological emergencies</searchLink><br /><searchLink fieldCode="DE" term="%22Status+epilepticus%22">Status epilepticus</searchLink><br /><searchLink fieldCode="DE" term="%22Anticonvulsants%22">Anticonvulsants</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+sciences%22">Medical sciences</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink>
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  Data: Background: New Onset Refractory Status Epilepticus (NORSE) is a neurological emergency with high mortality. Cryptogenic NORSE (cNORSE) is defined by a lack of an identifiable structural, toxic or metabolic etiology despite extensive workup. Survivors often develop significant long-term neurological sequelae and drug-resistant epilepsy. However, studies have shown that despite prolonged hospitalization, a significant proportion of cNORSE patients can achieve favourable functional outcomes. Methods: A retrospective review of adult cNORSE patients between July 2019 and July 2023 in a tertiary hospital in Singapore was performed. Results: Thirteen patients with cNORSE were identified. Median age at presentation was 32.2 [IQR: 23.9–44.1] years and 6 (46.2%) of the patients were male. Eight (61.5%) patients fulfilled criteria for Febrile Infection-Related Epilepsy Syndrome (FIRES). Eight (61.5%) patients had abnormal index brain MRIs. The median duration of ICU stay was 37.0 [22.8–41.5] days. The total number of anti-seizure medications (ASMs) and anesthetics used was 6 [5–7] and 3 [2–4] respectively. All patients received immunotherapy and the time to immunotherapy initiation from SE onset was 2 [1–3] days. 4 (30.8%) patients demised during inpatient stay. Of 9 surviving patients, the median MRS on discharge was 4 [3–5]. MRS at 3 month and 1 year follow ups was 2 [1–5] and 1.0 [0.8-5.0] respectively. Conclusions: This retrospective study characterizes a cryptogenic NORSE cohort in a tertiary hospital in Singapore. Cryptogenic NORSE is associated with significant morbidity and mortality; however, long term outcomes may still be favourable in patients with initially severe illness and protracted ICU stay. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Neurological Sciences is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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              Text: Jun2025
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