ArticleEpilepsia2026
An extreme type of new onset refractory status epilepticus with stimulus-induced seizures in pharmacological isoelectric states.
Article in Epilepsia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
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7 authors.
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Abstract
objectiveStatus epilepticus (SE) is a common neurological emergency associated with high morbidity and mortality. SE is classified as refractory when it persists despite benzodiazepine and second-line antiseizure medication. Managing refractory SE in the intensive care setting often requires high doses of sedative drugs, which can induce burst suppression or complete electrical suppression (amplitude < 10 μV). We aimed to investigate the characteristics of persistent epileptic seizures in patients undergoing pharmacologically induced electrical suppression for treatment of refractory SE.
methodsWe retrospectively screened our hospital electroencephalographic (EEG) database for patients admitted to the neurointensive care unit with SE and a new onset refractory status epilepticus (NORSE) diagnosis from 2006 to 2024 (N = 65). Patients with persistent seizures despite a suppressed EEG were included. EEG, biological, and clinical data and outcomes were collected.
resultsWe identified seven patients with persistent electrical seizures despite pharmacologically induced electrical suppression lasting >1 min. All had cryptogenic NORSE (c-NORSE), preceded by a febrile event, and showed cerebrospinal fluid inflammation. Electrical suppression was achieved using three to four sedative drugs, including a barbiturate. A specific seizure onset EEG pattern was identified in all, characterized by periodic and/or rhythmic generalized discharges (GDs), followed by faster, lower amplitude rhythmic activity. In two patients, increased sedation revealed a second seizure onset pattern, characterized by abrupt rhythmic activity over isoelectric EEG background, independent of GDs. In six patients, multimodal stimuli (auditory, visual, or tactile) triggered either seizures, interictal high-amplitude GDs, or both. Repeated stimuli were associated with small-amplitude evoked potentials. All patients died in the intensive care unit. SIGNIFICANCE: We report a series of seven c-NORSE patients with a rare and extremely severe presentation: persistent and stimulus-induced seizures occurring over an electrically suppressed EEG background. This hyperexcitability state may result from cellular and network alterations induced by phenobarbital in patients with central nervous system inflammation.
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