View in EDS

Exploring pathways leading to drug‐resistant epilepsy for patients with cryptogenic new onset refractory status epilepticus.

Saved in:
Bibliographic Details
Title: Exploring pathways leading to drug‐resistant epilepsy for patients with cryptogenic new onset refractory status epilepticus.
Authors: Hanin, Aurélie (AUTHOR), Marois, Clémence (AUTHOR), Guillemaud, Martin (AUTHOR), Chavez, Mario (AUTHOR), Cosme, Léa (AUTHOR), Hayatou, Zineb (AUTHOR), Besnard, Aurore (AUTHOR), Goudard, Gwen (AUTHOR), Masson, Véronique (AUTHOR), Cousyn, Louis (AUTHOR), Cheval, Margaux (AUTHOR), Denis, Jérôme A. (AUTHOR), Alkouri, Rana (AUTHOR), Lamari, Foudil (AUTHOR), Bisulli, Francesca (AUTHOR), Eschbach, Krista (AUTHOR), Farias‐Moeller, Raquel (AUTHOR), Gaspard, Nicolas (AUTHOR), Gerard, Elizabeth E. (AUTHOR), Giovannini, Giada (AUTHOR)
Source: Epilepsia (Series 4). May2026, Vol. 67 Issue 5, p2326-2346. 21p.
Subjects: Status epilepticus, Biomarkers, Epilepsy, Central nervous system injuries, Immune response, Inflammatory mediators, Anticonvulsants
Abstract: Objective: Cryptogenic new onset refractory status epilepticus (cNORSE) carries high risks of long‐term disability and post‐NORSE epilepsy, but mechanisms remain unclear. We aimed to assess the predictive value of inflammatory and brain injury biomarkers and determine whether immune disturbances persist in the chronic phase. Methods: We enrolled 93 cNORSE patients from the Pitié‐Salpêtrière Hospital and the Yale NORSE/FIRES biorepository (2013–2025). Serum and cerebrospinal fluid (CSF) samples were collected during status epilepticus (SE), with outcomes assessed 6–12 months after resolution. To investigate post‐cNORSE epilepsy, we compared 39 post‐cNORSE patients (25 with paired acute samples) to 40 patients with temporal lobe epilepsy due to hippocampal sclerosis (TLE‐HS) and 20 with chronic immune‐mediated encephalitis. Results: During cNORSE, elevated innate cytokines (serum CXCL8, CCL2; CSF IL‐6, CXCL8, CCL2, MIP‐1α, G‐CSF) and brain injury biomarkers (serum and CSF neurofilament light chain [NfL], CSF neuron‐specific enolase) correlated with worse functional outcomes. Multivariate models demonstrated that adding serum NfL to cytokines improved poor outcome prediction (area under the curve =.75). In contrast, no acute biomarker predicted post‐cNORSE epilepsy, which was instead associated with prolonged SE, magnetic resonance imaging abnormalities, and the need for more intensive treatment. In paired analyses, most serum cytokines normalized during the chronic phase, particularly IL‐6, IL‐10, and IL‐1β, although new adaptive immune disturbances (IL‐17A, IL‐12p70, TNFα) appeared in 20% of patients. No chronic elevations of innate cytokines were observed in post‐cNORSE patients. Conversely, elevated age‐adjusted NfL levels were more frequent in post‐cNORSE epilepsy (64%) than encephalitis (45%) and TLE‐HS (20%), (p <.001), with elevated NfL levels correlating with poor functional outcomes (p =.019). Significance: Innate immune activation is a hallmark of acute cNORSE but largely resolves in the chronic phase, arguing against persistent innate inflammation as the driver of post‐cNORSE epilepsy. In contrast, persistently elevated NfL levels suggest ongoing axonal injury, potentially contributing to poor outcomes. Integrating inflammatory and neuroaxonal injury biomarkers may improve risk stratification and guide long‐term management. [ABSTRACT FROM AUTHOR]
Copyright of Epilepsia (Series 4) is the property of Wiley-Blackwell 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
FullText Text:
  Availability: 0
Header DbId: pbh
DbLabel: Psychology and Behavioral Sciences Collection
An: 193814294
AccessLevel: 6
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Exploring pathways leading to drug‐resistant epilepsy for patients with cryptogenic new onset refractory status epilepticus.
– Name: Author
  Label: Authors
  Group: Au
  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Hanin%2C+Aur&#233;lie%22&quot;&gt;Hanin, Aur&#233;lie&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Marois%2C+Cl&#233;mence%22&quot;&gt;Marois, Cl&#233;mence&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Guillemaud%2C+Martin%22&quot;&gt;Guillemaud, Martin&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Chavez%2C+Mario%22&quot;&gt;Chavez, Mario&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Cosme%2C+L&#233;a%22&quot;&gt;Cosme, L&#233;a&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Hayatou%2C+Zineb%22&quot;&gt;Hayatou, Zineb&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Besnard%2C+Aurore%22&quot;&gt;Besnard, Aurore&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Goudard%2C+Gwen%22&quot;&gt;Goudard, Gwen&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Masson%2C+V&#233;ronique%22&quot;&gt;Masson, V&#233;ronique&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Cousyn%2C+Louis%22&quot;&gt;Cousyn, Louis&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Cheval%2C+Margaux%22&quot;&gt;Cheval, Margaux&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Denis%2C+J&#233;r&#244;me+A%2E%22&quot;&gt;Denis, J&#233;r&#244;me A.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Alkouri%2C+Rana%22&quot;&gt;Alkouri, Rana&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Lamari%2C+Foudil%22&quot;&gt;Lamari, Foudil&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Bisulli%2C+Francesca%22&quot;&gt;Bisulli, Francesca&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Eschbach%2C+Krista%22&quot;&gt;Eschbach, Krista&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Farias‐Moeller%2C+Raquel%22&quot;&gt;Farias‐Moeller, Raquel&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Gaspard%2C+Nicolas%22&quot;&gt;Gaspard, Nicolas&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Gerard%2C+Elizabeth+E%2E%22&quot;&gt;Gerard, Elizabeth E.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Giovannini%2C+Giada%22&quot;&gt;Giovannini, Giada&lt;/searchLink&gt; (AUTHOR)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Epilepsia+%28Series+4%29%22&quot;&gt;Epilepsia (Series 4)&lt;/searchLink&gt;. May2026, Vol. 67 Issue 5, p2326-2346. 21p.
– Name: Subject
  Label: Subjects
  Group: Su
  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Status+epilepticus%22&quot;&gt;Status epilepticus&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Biomarkers%22&quot;&gt;Biomarkers&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Epilepsy%22&quot;&gt;Epilepsy&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Central+nervous+system+injuries%22&quot;&gt;Central nervous system injuries&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Immune+response%22&quot;&gt;Immune response&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Inflammatory+mediators%22&quot;&gt;Inflammatory mediators&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Anticonvulsants%22&quot;&gt;Anticonvulsants&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: Cryptogenic new onset refractory status epilepticus (cNORSE) carries high risks of long‐term disability and post‐NORSE epilepsy, but mechanisms remain unclear. We aimed to assess the predictive value of inflammatory and brain injury biomarkers and determine whether immune disturbances persist in the chronic phase. Methods: We enrolled 93 cNORSE patients from the Piti&#233;‐Salp&#234;tri&#232;re Hospital and the Yale NORSE/FIRES biorepository (2013–2025). Serum and cerebrospinal fluid (CSF) samples were collected during status epilepticus (SE), with outcomes assessed 6–12 months after resolution. To investigate post‐cNORSE epilepsy, we compared 39 post‐cNORSE patients (25 with paired acute samples) to 40 patients with temporal lobe epilepsy due to hippocampal sclerosis (TLE‐HS) and 20 with chronic immune‐mediated encephalitis. Results: During cNORSE, elevated innate cytokines (serum CXCL8, CCL2; CSF IL‐6, CXCL8, CCL2, MIP‐1α, G‐CSF) and brain injury biomarkers (serum and CSF neurofilament light chain [NfL], CSF neuron‐specific enolase) correlated with worse functional outcomes. Multivariate models demonstrated that adding serum NfL to cytokines improved poor outcome prediction (area under the curve =.75). In contrast, no acute biomarker predicted post‐cNORSE epilepsy, which was instead associated with prolonged SE, magnetic resonance imaging abnormalities, and the need for more intensive treatment. In paired analyses, most serum cytokines normalized during the chronic phase, particularly IL‐6, IL‐10, and IL‐1β, although new adaptive immune disturbances (IL‐17A, IL‐12p70, TNFα) appeared in 20% of patients. No chronic elevations of innate cytokines were observed in post‐cNORSE patients. Conversely, elevated age‐adjusted NfL levels were more frequent in post‐cNORSE epilepsy (64%) than encephalitis (45%) and TLE‐HS (20%), (p &lt;.001), with elevated NfL levels correlating with poor functional outcomes (p =.019). Significance: Innate immune activation is a hallmark of acute cNORSE but largely resolves in the chronic phase, arguing against persistent innate inflammation as the driver of post‐cNORSE epilepsy. In contrast, persistently elevated NfL levels suggest ongoing axonal injury, potentially contributing to poor outcomes. Integrating inflammatory and neuroaxonal injury biomarkers may improve risk stratification and guide long‐term management. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: &lt;i&gt;Copyright of Epilepsia (Series 4) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;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.&lt;/i&gt; (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=193814294
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1002/epi.70146
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 21
        StartPage: 2326
    Subjects:
      – SubjectFull: Status epilepticus
        Type: general
      – SubjectFull: Biomarkers
        Type: general
      – SubjectFull: Epilepsy
        Type: general
      – SubjectFull: Central nervous system injuries
        Type: general
      – SubjectFull: Immune response
        Type: general
      – SubjectFull: Inflammatory mediators
        Type: general
      – SubjectFull: Anticonvulsants
        Type: general
    Titles:
      – TitleFull: Exploring pathways leading to drug‐resistant epilepsy for patients with cryptogenic new onset refractory status epilepticus.
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Hanin, Aurélie
      – PersonEntity:
          Name:
            NameFull: Marois, Clémence
      – PersonEntity:
          Name:
            NameFull: Guillemaud, Martin
      – PersonEntity:
          Name:
            NameFull: Chavez, Mario
      – PersonEntity:
          Name:
            NameFull: Cosme, Léa
      – PersonEntity:
          Name:
            NameFull: Hayatou, Zineb
      – PersonEntity:
          Name:
            NameFull: Besnard, Aurore
      – PersonEntity:
          Name:
            NameFull: Goudard, Gwen
      – PersonEntity:
          Name:
            NameFull: Masson, Véronique
      – PersonEntity:
          Name:
            NameFull: Cousyn, Louis
      – PersonEntity:
          Name:
            NameFull: Cheval, Margaux
      – PersonEntity:
          Name:
            NameFull: Denis, Jérôme A.
      – PersonEntity:
          Name:
            NameFull: Alkouri, Rana
      – PersonEntity:
          Name:
            NameFull: Lamari, Foudil
      – PersonEntity:
          Name:
            NameFull: Bisulli, Francesca
      – PersonEntity:
          Name:
            NameFull: Eschbach, Krista
      – PersonEntity:
          Name:
            NameFull: Farias‐Moeller, Raquel
      – PersonEntity:
          Name:
            NameFull: Gaspard, Nicolas
      – PersonEntity:
          Name:
            NameFull: Gerard, Elizabeth E.
      – PersonEntity:
          Name:
            NameFull: Giovannini, Giada
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 05
              Text: May2026
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 00139580
          Numbering:
            – Type: volume
              Value: 67
            – Type: issue
              Value: 5
          Titles:
            – TitleFull: Epilepsia (Series 4)
              Type: main
ResultId 1