Heuer Christine, Togni Claudio, Galovic Marian, Czernuszenko Anna, Brandi Giovanna, de Trizio Ignazio
Institute for Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
Department of Neurology and Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.
Epilepsy Behav Rep. 2024 Sep 16;28:100710. doi: 10.1016/j.ebr.2024.100710. eCollection 2024.
We report a unique case of super-refractory status epilepticus (SRSE) secondary to tick-borne encephalitis (TBE) to evaluate the therapeutic challenges and potential benefits of steroid treatment in this context. A previously healthy 31-year-old woman was admitted to the hospital with fever, headache, vertigo, and meningismus, ultimately diagnosed with TBE. Despite empirical antimicrobial treatment, the patient's condition deteriorated, leading to coma and SRSE. Various antiseizure medications and sedatives were administered without sustained success. Steroid treatment was initiated due to elevated intracranial pressure and persistent seizure activity. Following the administration of dexamethasone, electrographic status epilepticus resolved, though the patient developed clinical signs of increased intracranial pressure necessitating decompressive craniectomy. The patient's condition stabilized with a combination of antiseizure medicazions. Despite cessation of SRSE, the patient remained in a minimally conscious state at discharge, showing only gradual improvement over time. The use of steroids in TBE is controversial, with limited reports of potential benefits. In this case, steroid administration coincided with the cessation of SRSE, and authors explore its potential benefit considering its immunomodulatory effects.
我们报告了一例由蜱传脑炎（TBE）继发的超级难治性癫痫持续状态（SRSE）的独特病例，以评估在这种情况下类固醇治疗的挑战和潜在益处。一名此前健康的31岁女性因发热、头痛、眩晕和颈项强直入院，最终被诊断为TBE。尽管进行了经验性抗菌治疗，但患者病情恶化，导致昏迷和SRSE。使用了各种抗癫痫药物和镇静剂，但均未取得持续成功。由于颅内压升高和持续的癫痫活动，开始使用类固醇治疗。给予地塞米松后，脑电图癫痫持续状态得到缓解，尽管患者出现了颅内压升高的临床体征，需要进行减压颅骨切除术。患者的病情通过抗癫痫药物的联合使用得以稳定。尽管SRSE停止，但患者出院时仍处于最低意识状态，仅随着时间的推移逐渐改善。在TBE中使用类固醇存在争议，关于潜在益处的报道有限。在本病例中，类固醇给药与SRSE停止同时发生，作者考虑到其免疫调节作用探讨了其潜在益处。
