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. |
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| 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] |
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| Database: | Psychology and Behavioral Sciences Collection |
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| 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] |
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| ISSN: | 15901874 |
| DOI: | 10.1007/s10072-025-08082-1 |
