A case of new-onset refractory status epilepticus (NORSE) due to Herpes Simplex Virus-1 encephalitis

In the medical literature, the term of "new-onset refractory status epilepticus" (NORSE) is a novel term. Herpes Simplex Virus-1 and other viral infections can be cause to NORSE. Seizures are a rare sign of HSV encephalitis, but they can occur as the first symptom. Herein, we present a case of NORSE triggered by HSV-1 encephalitis, which had been diagnosed via cerebrospinal fluid polymerase chain reaction (PCR) method and magnetic resonance imaging findings.

___

  • 1. Hirsch LJ, Gaspard N, van Baalen A, et al. Proposed consensus definitions for new-onset refractory status epilepticus (NORSE), febrile infection-related epilepsy syndrome (FIRES), and related conditions. Epilepsia 2018; 59: 739–44.
  • 2. Specchio N, Pietrafusa N. New-onset refractory status epilepticus and febrile infection-related epilepsy syndrome. Dev Med Child Neurol 2020;62(8):897-905.
  • 3. Iizuka T, Kanazawa N, Kaneko J, et al. Cryptogenic NORSE: its distinctive clinical features and response to immunotherapy. Neurol Neuroimmunol Neuroinflamm 2017; 4: e396.
  • 4. Bradshaw MJ, Venkatesan A. Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management. Neurotherapeutics 2016;13(3):493-508.
  • 5. Rabinstein AA. Herpes Virus Encephalitis in Adults: Current Knowledge and Old Myths. Neurol Clin 2017;35(4):695-705.
  • 6. Riancho J, Delgado-Alvarado M, Sedano MJ, Polo JM, Berciano J. Herpes simplex encephalitis: clinical presentation, neurological sequelae and new prognostic factors. Ten years of experience. Neurol Sci 2013;34(10):1879-81.
  • 7. Fotedar N, Dolbow J, Layfield M, Thyagaraj S, Zande J. Epileptic negative myoclonus in herpes simplex virus encephalitis. Epileptic Disord 2021. doi: 10.1684/epd.2021.1401.
  • 8. Laohathai C, Weber DJ, Hayat G, Thomas FP. Chronic herpes simplex type-1 encephalitis with intractable epilepsy in an immunosuppressed patient. Infection 2016;44(1):121-5.
  • 9. Michael BD, Solomon T. Seizures and encephalitis: clinical features, management, and potential pathophysiologic mechanisms. Epilepsia. 2012 Sep;53 Suppl 4:63-71.
  • 10. Herpes Simplex Encephalitis. https://emedicine.medscape.com/article/1165183-overview. [Accessed 10 February 2022].
  • 11. Misra UK, Tan CT, Kalita J. Viral encephalitis and epilepsy. Epilepsia 2008;49 Suppl 6:13-8.
  • 12. Solomon T, Michael BD, Smith PE, Sanderson F, Davies NWS, Hart IJ, et al, On behalf of the National Encephalitis Guidelines Development Group. Management of suspected viral encephalitis in adults: Association of British Neurologists and British Infection Association National Guideline. J Infect 2012; 64:347–73.