Clinical analysis of 11 cases of severe acute viral encephalitis combined with Super-Refractory Status Epilepticus

Objective To investigate the clinical characteristics, diagnosis and the treatment of severe acute viral encephalitis combined with Super-Refractory Status Epilepticus(SRSE). Methods The clinic files of 11 cases in our hospital were analyzed retrospective during the four years from September 2013 to June 2017. We had followed up the family member of these patients with the development of the disease process and the prognosis of disease. Results There were 6 males and 5 females with ages ranging from 17 to 71 years. All the patients had a history of prodromal infection, and seizures occurred within 0-8 days after the onset of the disease .10 patients underwent continuous video electroencephalogram (VEEG) examination, all results showed status epilepticus. Cerebrospinal fluid tests showed normal in one cases, while mild anomaly in 10 cases. Cerebrospinal fluid pressure increased in 6 cases, and virus detection was positive in 2 cases. Abnormal signals of brain CT or MRI were found in 4 cases. 2 cases showed diffuse cerebral edema and 2 cases showed frontotemporal abnormal signal. 9 cases of blood and cerebrospinal fluid autoimmune encephalitis antibody were detected, which demonstrated 8 cases of negative, and 1 cases of positive. All 11 patients received four or more antiepileptic drugs combined with two intravenous anesthetics and immunosuppressive agents treatment. During the course of the disease, 10 patients underwent endotracheal intubation, 5 of whom underwent tracheotomy. After the treatment, results showed that 9 cases had improvement, 1 case gave up treatment, and 1 case died. Conclusion Under VEEG monitoring, flexible intravenous anesthetics combined with adequate antiepileptic drugs and immunosuppressive agents are effective in the treatment of severe viral encephalitis combined with SRSE, and patients who received NICU specialist treatment can reduce mortality