<b>New Onset Refractory Status Epilepticus (NORSE) Lasting 110 Days Resulting in a Positive Outcome</b> (P3.198)
Bibliographic record
Abstract
Objective: We report the longest case of new onset refractory status epilepticus (NORSE) with a positive outcome. Background: New onset refractory status epilepticus (NORSE) is characterized by long-lasting seizures unresponsive to first line management. Severe disability and epilepsy are common outcomes. Methods: Case report Results: An 18-year-old female presented with several days of headache followed by seizures. Seizures became refractory within 24 hours. She was extensively investigated including CSF and MRI which were unremarkable. Serology was positive for anti-GAD antibodies. Seizures in ICU were mainly non-convulsive. There were several seizures consistent with stimulus induced rhythmic periodic ictal discharges (SIRPIDS), including occipital seizures during pupil checks. The patient received aggressive and early anticonvulsant and immunomodulatory treatment and continuous EEG monitoring in the ICU. Propofol was stopped early as a long course was anticipated. Seizures continued despite high doses of midazolam and ketamine infusions. A pentobarbital-induced coma was required to suppress the seizures and weaning resulted in return of seizures. Use of inhalational anesthetics provided very good suppression but was technically challenging. Ultimately, weaning of anesthetics was possible with levetiracetam, clobazam, topiramate, clonazepam, lacosamide, vigabatrin, and phenobarbital. Multiple immune modulatory medications were provided for treatment of presumed autoimmune encephalitis, including, corticosteroids, rituximab, IVIG, and plasma exchange. Despite the extended length of NORSE, the patient had a successful recovery achieving independent walking and is living at home with her family. Speech is relatively normal and seizures are infrequent. Impulsivity, memory, attention, and abstraction remain impaired. Conclusions: This represents the longest case of NORSE with good outcome. Early aggressive treatment with multiple synergistic mechanisms, including NMDA antagonists, and immune suppression may allow for recovery even after very prolonged seizures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".