Comparative Analysis of New-onset Refractory Status Epilepticus (NORSE) in Adult and Pediatric Patients: Immunotherapy Timing and Functional Outcomes
Abstract number :
1.346
Submission category :
4. Clinical Epilepsy / 4D. Prognosis
Year :
2024
Submission ID :
1272
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Lubna Halawani, MD – McGill University
Kenneth Myers, MD, PhD, FRCPC – Research Institute of the McGill University Health Centre
Rationale: Immunotherapy timing is hypothesized to play a crucial role in modulating the inflammatory response associated with NORSE, potentially improving patient outcomes. This study investigated the impact of immunotherapy timing on intensive care unit (ICU) stay duration and functional outcomes in adults and children with NORSE.
Methods: We reviewed all patients with a diagnosis of NORSE admitted at McGill University Health Centre between January 2013 and July 2023. We evaluated demographics, diagnostics, treatments, ICU stay length, long-term anti-seizure medication use, and modified Rankin Scale (mRS) scores at discharge, defining good outcomes as mRS 0-2 and poor outcomes as mRS 3-6. Early initiation of immunotherapy was defined as administration of a first-line agent within 7 days of admission and second line agent escalation within 30 days. Comparisons were made between adult and pediatric patients.
Results: 15 NORSE patients were identified (10 adult, 5 pediatric) with median ages of 34 and 4 years, respectively. Early initiation of first-line immunotherapies correlated with shorter adult ICU stays (r = 0.748, p = 0.021), however not in children. Delayed chronic immunosuppression escalation was associated with shorter ICU stays in children (r = -0.995, p = 0.005); no significant association was seen in adults, however ICU stays tended to be longer (r = 0.689, p = 0.130). Better functional outcomes at discharge were observed among children that had earlier escalation of chronic immunosuppression (r = 0.943, p = 0.057), contrasting with adults who, likely due to more severe disease, did not exhibit similar outcomes.
Conclusions: This study suggests that early initiation of immunotherapy reduces ICU stays in adults and improves functional outcomes in children at discharge. However, contrasting outcomes are observed with prompt escalation to chronic immunosuppresion between adults and children highlighting the need to tailor the timing of immunotherapy for NORSE patients across age groups while accounting for disparities in disease severity between pediatric and adult cohorts. Further investigation into age-specific factors may guide more targeted therapeutic approaches.
Funding: No funding was received.
Clinical Epilepsy