Immunotherapy in NORSE- A Case Report:

Anjani Bala; Manoj Kumar  Singh; Abhishek  Kumar; Munish  Kumar

Anjani Bala Junior Resident, Department of Pediatrics, Patna Medical College, Patna, Bihar, India
Manoj Kumar Singh Associate Professor, Department of Pediatrics, Patna Medical College, Patna, Bihar, India
Abhishek Kumar Senior Resident, Department of Pediatrics, Patna Medical College, Patna, Bihar, India
Munish Kumar Assistant Professor, Department of Neurology, Patna Medical College, Patna, Bihar, India

Keywords: Refractory status epilepticus, NORSE, Immunotherapy

Abstract

We present the case of a healthy five-year-old girl who presented with fever followed by refractory status epilepticus. Admitted to the intensive care unit, was managed with intravenous midazolam and first line antiepileptic drugs in loading doses. Seizure continued even then, so other antiepileptic medications were titrated to therapeutic doses. Intravenous acyclovir added in view of possibility of viral encephalitis. She also received high dose intravenous methyl prednisolone. Complete remission of seizure can’t be achieved in spite of several antiepileptic drugs. Lastly Intravenous immunoglobulin administered which caused dramatic improvement in clinical condition and complete seizure control. Laboratory investigation including autoimmune and paraneoplastic studies, CSF analysis yielded negative results. MRI brain nothing significant. Our case fulfils the definition of new-onset refractory status epilepticus (NORSE).

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