Autoimmune encephalitis is the most commonly identified cause of new-onset refractory status epilepticus, but half remain cryptogenic, according to a study of 130 patients with refractory status status epilepticus. Researchers found:
• 52% of cases remained cryptogenic.
• Most commonly identified etiologies were autoimmune (19%) and paraneoplastic (18%) encephalitis.
• Poor outcomes occurred in 62% of patients and 22% died.
• Predictors of poor outcome included duration of status epilepticus, use of anesthetics, and medical complications.
• Among patients with available follow-up data, functional status improved in 57% and 79% had good or fair outcome at last follow-up; however, epilepsy developed in 37% with most survivors (92%) remaining on antiseizure medications.
• Immune therapies were used less frequently in cryptogenic, despite a comparable prevalence of inflammatory cerebrospinal fluid changes.
Citation: Gaspard N, Foreman BP, Alvarez V, et al. New-onset refractory status epilepticus. Published online ahead of print August 21, 2015]. Neurology. doi: http://dx.doi.org/10.1212/WNL.0000000000001940.