ArticleNeurology(R) neuroimmunology & neuroinflammation2025
Identification of Distinct Biological Groups of Patients With Cryptogenic NORSE via Inflammatory Profiling.
Article in Neurology(R) neuroimmunology & neuroinflammation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Maternal prenatal co-exposure to air pollution and psychological distress shapes the neonatal gut: microbiota-mediated pathways to early neurodevelopment.Gut microbes · 2026Article
- Infection-triggered encephalopathy syndromes: a meta-analysis of clinical characteristics and outcomes in 1946 cases.EClinicalMedicine · 2026Article
- Clinical outcomes and unmet therapeutic needs in new-onset refractory status epilepticus: evidence from a retrospective cohort.Neurological research and practice · 2026Article
- Early Recovery from Cryptogenic NORSE Following Repeated C-NORSE Score Assessment and Cyclophosphamide Treatment.Internal medicine (Tokyo, Japan) · 2026Article
- Exploring pathways leading to drug-resistant epilepsy for patients with cryptogenic new onset refractory status epilepticus.Epilepsia · 2026Article
- ANA Investigates: NORSE and FIRES.Annals of neurology · 2026Article
- Adaptive immune dysregulation drives new-onset refractory status epilepticus.Frontiers in immunology · 2026Review
- Blockade of Interleukin-6 Receptor with Tocilizumab During the Acute Phase of Childhood Immune-Mediated Epilepsy can Lead to a Favorable Outcome - an Observational Study.Current neuropharmacology · 2026Observational
- Annual Course / From Then to Now: The Evolving Spectrum of Epilepsy Care.Epilepsy currents · 2025Article
- Standard complete blood count to predict long-term outcomes in febrile infection-related epilepsy syndrome (FIRES): A multicenter study.Epilepsia · 2025Article
- Analysis of Early EEG Changes After Tocilizumab Treatment in New-Onset Refractory Status Epilepticus.Brain sciences · 2025Article
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Authors and funding
39 authors.
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Abstract
BACKGROUND AND
objectivesEmerging evidence suggests that immune dysregulation plays a pivotal role in triggering cryptogenic new-onset refractory status epilepticus (c-NORSE), prompting a consensus on early initiation of immunotherapy. However, despite similar timing of administration, responses to immunotherapies have been varied and unpredictable, suggesting the presence of heterogeneous underlying mechanisms
methodsSixty-two patients with c-NORSE were included. A comprehensive panel of 96 cytokines was analyzed in serum samples. Patients were clustered based on their cytokine profiles using the Louvain algorithm, an unsupervised graph-based clustering method. The identified clusters of patients were compared regarding cytokine levels and clinical features. Protein pathway analysis was used to explore the biological relevance of the inflammatory markers within each cluster. Patients with c-NORSE were compared with control patients (n = 18) and patients with other forms of refractory SE (n = 45).
resultsCompared with controls, patients with c-NORSE exhibited significant differences in 33 cytokines. Pathway analysis revealed dysregulations in chemotaxis and neutrophil recruitment and migration, highlighting the importance of innate immunity in patients with c-NORSE. Within the c-NORSE cohort, 3 clusters of patients emerged: cluster A, lacking specific inflammatory markers; cluster B, with a much stronger innate-immunity cytokine-driven inflammatory response compared with clusters A and C; and cluster C, defined by dysregulated autoimmune processes. Notably, patients in cluster B showed a statistically significant elevation of innate immune-related proinflammatory cytokines associated with leukocyte recruitment and degranulation. By contrast, those in cluster C showed activation of Janus kinase signal transducer and activator of transcription (JAK-STAT) pathways, suggesting autoimmune mechanisms. Patients in clusters B and C demonstrated varied responses to immunotherapies, with cluster C patients showing favorable outcomes after multiple immunotherapies. DISCUSSION: The identification of distinct inflammatory subgroups in c-NORSE suggests that variations in the underlying immune mechanisms contribute to differential treatment responses. These findings underscore the importance of personalized therapeutic strategies, potentially targeting specific inflammatory pathways, to optimize clinical outcomes in this challenging condition.
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