New Onset Refractory Status Epilepticus as a Manifestation of Tuberculosis of the Central Nervous System

Abstract

A 28-year-old male presented to us with new onset refractory status epilepticus. Prior to his seizures, he had a history of fever, headache and blurring of vision, for which he was admitted elsewhere. No cause was found; he was treated symptomatically and was discharged as his symptoms had abated. Post-discharge, he started having multiple seizures. Neuro-imaging suggested encephalitis. He progressed to status epilepticus and was referred to our center. We intensified the anti-epileptic medications but owing to no response, he had to be put under coma with thiopental, yet the seizures persisted. Workup for the etiology of his seizures was negative except for CSF TB-PCR (Gene Xpert) being positive and hence anti-tuberculous therapy was initiated. By this time, he developed rhabdomyolysis, and thereafter renal failure with dyselectrolytemia, and thus there was a plan to initiate dialysis. But before this could be done, he succumbed to a cardiac arrest secondary to ventricular tachyarrhythmias. We believe this to be the first reported case of new onset refractory status epilepticus secondary to tuberculosis of the central nervous system.

Neuromodulation in new-onset refractory status epilepticus

“…Twelve out of 20 patients were male. Nine out of 20 patients were children (<18) and all except two (44,45) had a diagnosis of FIRES. Seven out of 20 patients presented with NORSE, and the etiology was confirmed only in three (45)(46)(47) out of 20, with all the other cases remaining cryptogenic.…”

“…Regarding the overall outcomes, of the 17 survivors, 11 had persistent epilepsy (43)(44)(45)(49)(50)(51)(52)(53)(54), 12 had cognitive and/or motor dysfunction (43, 45-47, 49-53, 55, 56), and one remained in a vegetative state (50).…”

“…ECT was performed in 10 patients and was successful in resolving SE in nine of those cases (44,(51)(52)(53)(54)56). VNS was implanted in seven patients and was successful in resolving SE in five of those cases (43, 46-49, 55, 57).…”