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. 2023 Jun 14:14:1195844.
doi: 10.3389/fneur.2023.1195844. eCollection 2023.

Neuromodulation in new-onset refractory status epilepticus

Ioannis Stavropoulos #  1   2 , Jin Han Khaw #  3 , Antonio Valentin  1   2
Affiliations

Neuromodulation in new-onset refractory status epilepticus

Ioannis Stavropoulos et al. Front Neurol. .

Abstract

Background: New-onset refractory status epilepticus (NORSE) and its subset of febrile infection-related epilepsy syndrome (FIRES) are devastating clinical presentations with high rates of mortality and morbidity. The recently published consensus on the treatment of these conditions includes anesthetics, antiseizure drugs, antivirals, antibiotics, and immune therapies. Despite the internationally accepted treatment, the outcome remains poor for a significant percentage of patients.

Methods: We conducted a systematic review of the use of neuromodulation techniques in the treatment of the acute phase of NORSE/FIRES using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: Our search strategy brought up 74 articles of which 15 met our inclusion criteria. A total of 20 patients were treated with neuromodulation. Thirteen cases represented FIRES and in 17 cases the NORSE remained cryptogenic. Ten had electroconvulsive therapy (ECT), seven had vagal nerve stimulation (VNS), and four had deep brain stimulation (DBS); one patient had initially VNS and later DBS. Eight patients were female and nine were children. In 17 out of 20 patients, the status epilepticus was resolved after neuromodulation, while three patients died.

Conclusion: NORSE can have a catastrophic course and the first treatment goal should be the fastest possible termination of status epilepticus. The data presented are limited by the small number of published cases and the variability of neuromodulation protocols used. However, they show some potential clinical benefits of early neuromodulation therapy, suggesting that these techniques could be considered within the course of FIRES/NORSE.

Keywords: deep brain stimulation (DBS); electroconvulsive therapy (ECT); febrile infection epilepsy-related syndrome (FIRES); neuromodulation; new-onset refractory status epilepticus (NORSE); vagal nerve stimulation (VNS).

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Conflict of interest statement

AV has received honorarium for lectures and consultancy from Medtronic Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart for choice of included studies.
Figure 2
Figure 2
Number of patients reported for each type of neuromodulation including outcome.
Figure 3
Figure 3
The relationship between time before initiating neuromodulation after onset of SE and time before resolution of SE after neuromodulation, categorized by type of neuromodulation technique.
Figure 4
Figure 4
Percentage of patients who received each medication or treatment during management of NORSE/FIRES.
See this image and copyright information in PMC

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