{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T01:34:22Z","timestamp":1780450462175,"version":"3.54.1"},"reference-count":21,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,6,4]],"date-time":"2015-06-04T00:00:00Z","timestamp":1433376000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:p>New\u2010onset refractory status epilepticus (<jats:styled-content style=\"fixed-case\">NORSE<\/jats:styled-content>) is defined as a sudden onset of refractory status epilepticus in patients who do not have a history of epilepsy. It is a neurologic emergency, and determining the underlying etiology is an important factor for effectively managing and predicting the prognosis of <jats:styled-content style=\"fixed-case\">NORSE<\/jats:styled-content>. We describe the case of a 28\u2010year\u2010old woman who was hospitalized with <jats:styled-content style=\"fixed-case\">NORSE<\/jats:styled-content> secondary to an unknown etiology. She did not respond to traditional anticonvulsant therapy, including benzodiazepines, fosphenytoin, propofol, and levetiracetam. The patient was placed on continuous electroencephalography (<jats:styled-content style=\"fixed-case\">EEG<\/jats:styled-content>) monitoring and was treated further with multiple antiepileptics, which were titrated aggressively based on <jats:styled-content style=\"fixed-case\">EEG<\/jats:styled-content> readings and therapeutic drug levels; despite this treatment, <jats:styled-content style=\"fixed-case\">EEG<\/jats:styled-content> monitoring revealed continued seizures. Thus, high\u2010dose corticosteroids were started for seizure control. Her workup included computed tomography and magnetic resonance imaging of the head, a lumbar puncture, toxicology screening, and extensive testing for multiple infectious and inflammatory etiologies. The patient's history revealed recent exposure to a new cat. Serologic results were positive for <jats:italic>Bartonella henselae<\/jats:italic>, and she was diagnosed with cat\u2010scratch disease (<jats:styled-content style=\"fixed-case\">CSD<\/jats:styled-content>). She did not have the typical presentation of symptoms of lymphadenopathy, however, which is common in <jats:styled-content style=\"fixed-case\">CSD<\/jats:styled-content>. Doxycycline 100\u00a0mg and rifampin 300\u00a0mg twice daily were added to the patient's anticonvulsant and corticosteroid therapy. She was hospitalized for a total of 26\u00a0days and discharged with only minor neurologic impairment (short\u2010term memory deficits and minor cognitive problems). The patient was discharged receiving antiepileptics, antibiotics, and a corticosteroid taper. To our knowledge, this is the first clinically known case of <jats:styled-content style=\"fixed-case\">NORSE<\/jats:styled-content> secondary to <jats:styled-content style=\"fixed-case\">CSD<\/jats:styled-content> without typical <jats:styled-content style=\"fixed-case\">CSD<\/jats:styled-content> symptoms in the adult population. The patient failed to respond to traditional anticonvulsant therapy alone. With the addition of high\u2010dose corticosteroids to aggressive anticonvulsant therapy, seizure control was achieved. Further studies are needed to determine the effectiveness of high\u2010dose corticosteroid and anticonvulsant therapy followed by antibiotics in patients with <jats:styled-content style=\"fixed-case\">NORSE<\/jats:styled-content> secondary to <jats:styled-content style=\"fixed-case\">CSD<\/jats:styled-content>.<\/jats:p>","DOI":"10.1002\/phar.1595","type":"journal-article","created":{"date-parts":[[2015,6,5]],"date-time":"2015-06-05T01:55:08Z","timestamp":1433469308000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["New\u2010Onset Refractory Status Epilepticus in an Adult with an Atypical Presentation of Cat\u2010Scratch Disease: Successful Treatment with High\u2010Dose Corticosteroids"],"prefix":"10.1002","volume":"35","author":[{"given":"Emily M.","family":"Laswell","sequence":"first","affiliation":[{"name":"Cedarville University School of Pharmacy Cedarville Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasandra D.","family":"Chambers","sequence":"additional","affiliation":[{"name":"Cedarville University School of Pharmacy Cedarville Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle R.","family":"Whitsel","sequence":"additional","affiliation":[{"name":"The Clinical Neuroscience Institute Miami Valley Hospital Dayton Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran","family":"Poudel","sequence":"additional","affiliation":[{"name":"The Clinical Neuroscience Institute Miami Valley Hospital Dayton Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,6,4]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-012-9695-z"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2012.03622.x"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2012.12.016"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awr215"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2008.10.007"},{"key":"e_1_2_5_7_1","unstructured":"The Center for Food Security and Public Health.Cat scratch disease and other zoonotic Bartonella infections.Ames (IO):The Center for Food Security and Public Health. 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