Drs. Joe Sirven and Nicolas Gaspard talk about NORSE, and FIRES, and new definitions to help patients and medical providers understand seizure emergencies.
Recorded June 2017
The term Status Epilepticus refers to a condition where seizures are continuous and do not stop.
Over the last several decades, the length of seizure that is considered as status epilepticus has shortened. Years ago, a seizure needed to last longer than 20 minutes to be considered status epilepticus. In the last few years, it is now defined as any seizure greater than 5 minutes. This makes sense because most seizures do not last longer than 2 minutes.
The longer a seizure lasts, the less likely it will stops on its own without medication. Very long seizures (i.e., status epilepticus) are dangerous and even increase the chance of death. It is important that these long seizures are identified early, so they can be treated early.
In this video. Dr. Matthew Hoerth speaks with Dr. Christopher Kramer, a neurointensive care specialist from the Mayo Clinic, regarding the importance of recognizing and treating status epilepticus. A paper published in the Neurocritical Care Journal from 2012 outlined guidelines for treating this neurologic emergency. This paper detailed the subtypes of status epilepticus, emphasized the high mortality rates of this condition, and summarized the best medical evidence for treatment.
New-onset refractory status epilepticus (NORSE) is defined as refractory status epilepticus without an obvious cause after initial investigations. “Initial” typically refers to 1 to 2 days, which is adequate time to rule out strokes, brain masses, drug overdoses, and herpes encephalitis. NORSE carries a high rate of complications and mortality, but a significant proportion of patients do eventually recover. Learn more here.
A much-needed registry of NORSE patients is now underway. The overall goals of this prospective observational registry of patients with cryptogenic NORSE is to define its cause, identify the key determinants of outcome, and determine best management strategies.
Inclusion criteria is SE refractory to first- and second-line therapy and no etiology found within the first three days despite extensive work-up in patients of age 5 and older.
The NORSE registry will be carried out by member centers of the Critical Care EEG Monitoring Research Consortium which currently is comprised of 41 medical centers, mostly in North America. Demographic, medical, and biological data (blood, serum CSF, brain biopsy if available) will be collected.
The study has the potential to help define the cause of NORSE, determine which medications warrant further investigations, and help identify key determinants of complications and outcomes in patients with refractory status epilepticus.
A detailed description of the registry is available from principal investigator Nicolas Gaspard.