Phenotype, outcome, interleukins, and miRNA levels assessment of new-onset refractory status epilepticus: A prospective cohort study

Abstract

Objectives: New-onset refractory status epilepticus (NORSE), a subtype of status epilepticus, poses a critical neurological emergency marked by considerable morbidity and mortality. This study aimed to characterize NORSE phenotypically and assess its outcomes, interleukin levels, and miRNA levels. Methods: Over a 3-year period, patients presenting with NORSE were enrolled. Clinical data were documented, and serum and cerebrospinal fluid (CSF) were collected for inflammatory marker analysis. Results were compared with matched controls, and statistical analyses were conducted. Results: The study comprised 37 patients (M: F—22: 15), with a median age of 23 (IQR: 14–31) years at presentation. The median hospital stay was 22 days, with an in-hospital mortality rate of 32%, and 51% of patients experienced poor outcomes at discharge. Approximately 62% required anesthetic agents and immunomodulators for seizure control, and 42% of survivors developed epilepsy during a mean 9-month follow-up. Serum and CSF levels of IL-6 and IL-8 were elevated in cases compared to controls, though serum IL-8 levels did not reach statistical significance. Levels of miRNA 132 and miRNA 134 were lower in cases than controls, but statistical analysis was limited by sample size. Significance: NORSE represents a grave neurological emergency with substantial mortality and morbidity as well as the development of epilepsy during follow-up. The study indicates upregulation of certain interleukins and downregulation of specific miRNA in the serum and CSF of NORSE patients, yet further investigation is warranted to establish correlations with prognosis, treatment response, and outcomes.