Plasma exchange in cryptogenic new onset refractory status epilepticus.
OBJECTIVE
New onset refractory status epilepticus (NORSE) is a recently described entity and has been difficult to treat because the etiology is often cryptogenic. Our aim in each case was to stop status epilepticus while simultaneously searching for the etiology.


METHODS
We describe three patients who presented with NORSE, who were refractory to multiple anticonvulsants and general anesthetics for at least 5 days. All patients had an extensive evaluation including MRI brain, CSF studies, radiologic scans for malignancy and serological autoimmune and infectious investigations.


RESULTS
Each patient responded dramatically to the use of plasma exchange therapy with cessation of status epilepticus by the fourth day of treatment. Although an etiology was sought after, no appropriate cause for NORSE could be found.


CONCLUSIONS
We propose early use of plasma exchange therapy (Class IV evidence) in hopes to prevent the complications of status epilepticus and prolonged hospitalization.
Barrow Neurological Institute, Phoenix, AZ, United States. jli1@phoenixchildrens.com
Judy
J
Li
Christina
C
Saldivar
Rama K
RK
Maganti
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000379:methods*; D013226:Status Epilepticus / Q000628:therapy*
D000927:Anticonvulsants