Cytokines in new-onset refractory status epilepticus: ready for clinical use?

New-onset refractory status epilepticus (NORSE) is a rare and challenging condition characterized by refractory status epilepticus in an otherwise healthy patient without obvious causes. Increasing evidence suggests a change in cytokine profiles in NORSE. However, the clinical utility of cytokine testing remains uncertain, primarily because of the lack of robust study designs and limited sample sizes. A recent study published in Annals of Neurology investigated the cytokine profiles in both serum and cerebrospinal fluid samples of NORSE patients. The study found elevated levels of CXCL8, CCL2, and MIP-1α in the serum and elevated levels of IL-1ß in the cerebrospinal fluid of NORSE patients compared to those with other forms of refractory status epilepticus (RSE). Furthermore, patients with cryptogenic NORSE had even higher levels of CXCL8, CCL2, and MIP-1α in the serum. Patients with NORSE who exhibited elevated levels of innate immunity cytokines in the serum had worse outcomes at discharge and several months after the NORSE ended. In summary, these findings highlight the association between inflammation-related cytokines and NORSE, providing new insights into clinical diagnosis and treatment approaches.