EARLY EEG monitoring identified electroencephalographic features associated with disease severity in new onset refractory status epilepticus (NORSE), suggesting that early neurophysiological assessment may help clinicians recognise patients at higher risk of prolonged intensive care admission and cognitive impairment.
New onset refractory status epilepticus is a rare neurological emergency characterised by refractory status epilepticus in individuals without a previous history of epilepsy and without an identifiable cause during the first 48 hours of presentation. Despite advances in critical care, predicting which patients will experience the most severe disease course remains difficult. Researchers therefore examined whether early electroencephalographic findings could distinguish NORSE from refractory status epilepticus not meeting NORSE criteria and provide clinically meaningful prognostic information.
The retrospective cohort study included 81 patients admitted to intensive therapy units between 2007 and 2023, comprising 29 patients with NORSE and 52 with refractory status epilepticus not meeting NORSE criteria. Researchers analysed electroencephalographic findings alongside treatment patterns and clinical outcomes to determine whether early recordings reflected disease severity.
Patients with NORSE demonstrated a substantially greater seizure burden than those with refractory status epilepticus not meeting NORSE criteria. Electroencephalographic recordings obtained within 72 hours of admission more frequently detected seizures in the NORSE group and revealed higher rates of interictal epileptiform discharges, sharp waves, and generalised periodic discharges. Across all electroencephalographic recordings, patients with NORSE also showed more frequent generalised periodic discharges, stimulus induced rhythmic, periodic, or ictal discharges, and burst suppression, all of which reflected a more severe electrographic profile.
Across the study population, higher seizure burden on the initial electroencephalographic recording correlated with longer intensive therapy unit admissions, greater antiseizure medication use, and poorer cognitive outcomes at discharge. Patients with NORSE also required more sedatives and antiseizure medications throughout admission and experienced significantly longer intensive therapy unit stays than patients with refractory status epilepticus not meeting NORSE criteria.
Although six month mortality was comparable between the groups, cognitive impairment at discharge occurred more frequently in patients with NORSE, highlighting the substantial long term neurological burden associated with the condition.
The findings suggest that early EEG monitoring could provide clinicians with valuable prognostic information during the first stages of admission. By identifying patients with greater seizure burden and characteristic electroencephalographic abnormalities, early monitoring may support more timely treatment escalation and improve clinical decision making in one of the most challenging neurological emergencies. The authors noted that larger multicentre studies are needed to validate these electroencephalographic markers and further define their role in guiding patient management.
Reference
Hawksworth S et al. New onset refractory status epilepticus (NORSE) versus refractory status epilepticus not meeting NORSE criteria: a comparative clinical and electroencephalography-based study. Epilepsia. 2026;DOI:10.1002/epi.70384.
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