新发难治性癫痫持续状态(NORSE)是一种临床表现,不是具体的诊断,在没有活动性癫痫或其他先前存在的相关神经系统疾病的患者中,新发作的难治性癫痫持续状态,没有明确的急性或活性结构,有毒,或代谢原因。“与发热感染相关的癫痫综合征(FIRES)是NORSE的一个子类别,需要事先进行发热感染,在难治性癫痫持续状态发作前2周至24小时开始发烧,在癫痫持续状态发作时有或不发烧。“这些适用于所有年龄段。广泛检测血液和脑脊液是否有传染性,风湿病,和代谢条件,神经影像学,脑电图,自身免疫/副肿瘤抗体评估,恶性肿瘤筛查,基因检测,和CSF宏基因组学可以揭示一些患者的病因,虽然很大一部分患者的疾病仍然无法解释,被称为病因不明的NORSE或隐源性NORSE。癫痫发作是耐火的,通常是超级耐火的(即,尽管麻醉24小时仍持续),需要长期住在重症监护室,经常(但不总是)有公平到糟糕的结果。最初24-48小时内的癫痫发作管理应该像任何难治性癫痫持续状态的病例一样。然而,根据已发布的共识建议,一线免疫疗法应在72小时内开始使用类固醇,静脉注射免疫球蛋白,或者血浆置换.如果没有改善,生酮饮食和二线免疫疗法应在7天内开始.如果有强烈的抗体介导的疾病的提示或证据,则推荐利妥昔单抗作为二线治疗。而对于隐源性病例,建议使用anakinra或tocilizumab。长时间住院后,通常需要加强运动和认知康复。许多患者在出院时会出现药物耐药性癫痫,有些可能需要持续的免疫疗法和癫痫手术评估.广泛的研究正在进行中,现在通过多国联盟涉及的特定类型的炎症,年龄和以前的发热疾病是否会影响这一点,以及测量和跟踪血清和/或CSF细胞因子是否可以帮助确定最佳治疗。
New-onset refractory status epilepticus (NORSE) is \"a clinical presentation, not a specific diagnosis, in a patient without active epilepsy or other preexisting relevant neurological disorder, with new onset of refractory status epilepticus without a clear acute or active structural, toxic, or metabolic cause.\" Febrile infection related epilepsy syndrome (FIRES) is \"a subcategory of NORSE that requires a prior febrile infection, with fever starting between 2 weeks and 24 h before the onset of refractory status epilepticus, with or without fever at the onset of status epilepticus.\" These apply to all ages. Extensive testing of blood and CSF for infectious, rheumatologic, and metabolic conditions, neuroimaging, EEG, autoimmune/paraneoplastic antibody evaluations, malignancy screen, genetic testing, and CSF metagenomics may reveal the etiology in some patients, while a significant proportion of patients\' disease remains unexplained, known as NORSE of unknown etiology or cryptogenic NORSE. Seizures are refractory and usually super-refractory (i.e., persist despite 24 h of anesthesia), requiring a prolonged intensive care unit stay, often (but not always) with fair to poor outcomes. Management of seizures in the initial 24-48 h should be like any case of refractory status epilepticus. However, based on the published consensus recommendations, the first-line immunotherapy should begin within 72 h using steroids, intravenous immunoglobulins, or plasmapheresis. If there is no improvement, the ketogenic diet and second-line immunotherapy should start within seven days. Rituximab is recommended as the second-line treatment if there is a strong suggestion or proof of an antibody-mediated disease, while anakinra or tocilizumab are recommended for cryptogenic cases. Intensive motor and cognitive rehab are usually necessary after a prolonged hospital stay. Many patients will have pharmacoresistant epilepsy at discharge, and some may need continued immunologic treatments and an epilepsy surgery evaluation. Extensive research is in progress now via multinational consortia relating to the specific type(s) of inflammation involved, whether age and prior febrile illness affect this, and whether measuring and following serum and/or CSF cytokines can help determine the best treatment.