Trends in management of patients with new‐onset refractory status epilepticus (NORSE) from 2016 to 2023: An interim analysis

医学 生酮饮食 阿纳基纳 癫痫持续状态 托珠单抗 内科学 癫痫 疾病 精神科
作者
Aurélie Hanin,Anthony D. Jimenez,Margaret Gopaul,Hannah Asbell,Seyhmus Aydemir,Maysaa Basha,Ayush Batra,Charlotte Damien,Gregory S. Day,Onome Eka,Krista Eschbach,Safoora Fatima,Madeline Fields,Brandon Foreman,Elizabeth E. Gerard,Teneille Gofton,Hiba A. Haider,Stephen Hantus,Sara E. Hocker,Amy C. Jongeling,Mariel Kalkach Aparicio,Padmaja Kandula,Peter Kang,Karnig Kazazian,Marissa Kellogg,Minjee Kim,Jong Woo Lee,Lara Marcuse,Christopher M. McGraw,Wazim Mohamed,Janet Orozco,Cederic M. Pimentel,Vineet Punia,Alexandra Martin Ramírez,Claude Steriade,Aaron F. Struck,Olga Taraschenko,Andrew Treister,Mark S. Wainwright,Ji Yeoun Yoo,Sahar F. Zafar,Daniel J. Zhou,Deepti Zutshi,Nicolas Gaspard,Lawrence J. Hirsch
出处
期刊:Epilepsia [Wiley]
卷期号:65 (8) 被引量:2
标识
DOI:10.1111/epi.18014
摘要

Abstract In response to the evolving treatment landscape for new‐onset refractory status epilepticus (NORSE) and the publication of consensus recommendations in 2022, we conducted a comparative analysis of NORSE management over time. Seventy‐seven patients were enrolled by 32 centers, from July 2016 to August 2023, in the NORSE/FIRES biorepository at Yale. Immunotherapy was administered to 88% of patients after a median of 3 days, with 52% receiving second‐line immunotherapy after a median of 12 days (anakinra 29%, rituximab 25%, and tocilizumab 19%). There was an increase in the use of second‐line immunotherapies (odds ratio [OR] = 1.4, 95% CI = 1.1–1.8) and ketogenic diet (OR = 1.8, 95% CI = 1.3–2.6) over time. Specifically, patients from 2022 to 2023 more frequently received second‐line immunotherapy (69% vs 40%; OR = 3.3; 95% CI = 1.3–8.9)—particularly anakinra (50% vs 13%; OR = 6.5; 95% CI = 2.3–21.0), and the ketogenic diet (OR = 6.8; 95% CI = 2.5–20.1)—than those before 2022. Among the 27 patients who received anakinra and/or tocilizumab, earlier administration after status epilepticus onset correlated with a shorter duration of status epilepticus ( ρ = .519, p = .005). Our findings indicate an evolution in NORSE management, emphasizing the increasing use of second‐line immunotherapies and the ketogenic diet. Future research will clarify the impact of these treatments and their timing on patient outcomes.
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