{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T22:14:08Z","timestamp":1773008048281,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T00:00:00Z","timestamp":1755907200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T00:00:00Z","timestamp":1755907200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR\u201010\u2010IAIHU\u201006"],"award-info":[{"award-number":["ANR\u201010\u2010IAIHU\u201006"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Status epilepticus (SE) is a common neurological emergency associated with high morbidity and mortality. SE is classified as refractory when it persists despite benzodiazepine and second\u2010line antiseizure medication. Managing refractory SE in the intensive care setting often requires high doses of sedative drugs, which can induce burst suppression or complete electrical suppression (amplitude &lt;\u200910\u2009\u03bcV). We aimed to investigate the characteristics of persistent epileptic seizures in patients undergoing pharmacologically induced electrical suppression for treatment of refractory SE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively screened our hospital electroencephalographic (EEG) database for patients admitted to the neurointensive care unit with SE and a new onset refractory status epilepticus (NORSE) diagnosis from 2006 to 2024 (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200965). Patients with persistent seizures despite a suppressed EEG were included. EEG, biological, and clinical data and outcomes were collected.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified seven patients with persistent electrical seizures despite pharmacologically induced electrical suppression lasting &gt;1 min. All had cryptogenic NORSE (c\u2010NORSE), preceded by a febrile event, and showed cerebrospinal fluid inflammation. Electrical suppression was achieved using three to four sedative drugs, including a barbiturate. A specific seizure onset EEG pattern was identified in all, characterized by periodic and\/or rhythmic generalized discharges (GDs), followed by faster, lower amplitude rhythmic activity. In two patients, increased sedation revealed a second seizure onset pattern, characterized by abrupt rhythmic activity over isoelectric EEG background, independent of GDs. In six patients, multimodal stimuli (auditory, visual, or tactile) triggered either seizures, interictal high\u2010amplitude GDs, or both. Repeated stimuli were associated with small\u2010amplitude evoked potentials. All patients died in the intensive care unit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>We report a series of seven c\u2010NORSE patients with a rare and extremely severe presentation: persistent and stimulus\u2010induced seizures occurring over an electrically suppressed EEG background. This hyperexcitability state may result from cellular and network alterations induced by phenobarbital in patients with central nervous system inflammation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/epi.18601","type":"journal-article","created":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T11:04:26Z","timestamp":1755947066000},"page":"138-150","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["An extreme type of new onset refractory status epilepticus with stimulus\u2010induced seizures in pharmacological isoelectric states"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5827-5678","authenticated-orcid":false,"given":"Julie","family":"L\u00e9vi\u2010Strauss","sequence":"first","affiliation":[{"name":"Assistance Publique \u2010 H\u00f4pitaux de Paris (AP\u2010HP), Epilepsy Unit and Electroencephalography Unit, Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital, Reference Center for Rare Epilepsies, European Reference Network EpiCARE  Paris France"},{"name":"Sorbonne Universit\u00e9, Paris Brain Institute, Institut du Cerveau, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM), Centre National de la Recherche Scientifique (CNRS), AP\u2010HP, H\u00f4pital Piti\u00e9\u2010Salp\u00eatri\u00e8re  Paris France"},{"name":"Universit\u00e9 Paris Cit\u00e9, Institut Pasteur, AP\u2010HP, INSERM, CNRS, Fondation Pour L'audition, Institut de L'audition, Institut Hospitalo\u2010Universitaire (IHU) reConnect  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7331-1182","authenticated-orcid":false,"given":"Vi\u2010Huong","family":"Nguyen\u2010Michel","sequence":"additional","affiliation":[{"name":"Assistance Publique \u2010 H\u00f4pitaux de Paris (AP\u2010HP), Epilepsy Unit and Electroencephalography Unit, Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital, Reference Center for Rare Epilepsies, European Reference Network EpiCARE  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3584-1956","authenticated-orcid":false,"given":"Esp\u00e1rtaco Moraes","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Assistance Publique \u2010 H\u00f4pitaux de Paris (AP\u2010HP), Epilepsy Unit and Electroencephalography Unit, Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital, Reference Center for Rare Epilepsies, European Reference Network EpiCARE  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9442-0302","authenticated-orcid":false,"given":"Virginie","family":"Lambrecq","sequence":"additional","affiliation":[{"name":"Assistance Publique \u2010 H\u00f4pitaux de Paris (AP\u2010HP), Epilepsy Unit and Electroencephalography Unit, Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital, Reference Center for Rare Epilepsies, European Reference Network EpiCARE  Paris France"},{"name":"Sorbonne Universit\u00e9, Paris Brain Institute, Institut du Cerveau, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM), Centre National de la Recherche Scientifique (CNRS), AP\u2010HP, H\u00f4pital Piti\u00e9\u2010Salp\u00eatri\u00e8re  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5912-9998","authenticated-orcid":false,"given":"Aur\u00e9lie","family":"Hanin","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, Paris Brain Institute, Institut du Cerveau, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM), Centre National de la Recherche Scientifique (CNRS), AP\u2010HP, H\u00f4pital Piti\u00e9\u2010Salp\u00eatri\u00e8re  Paris France"},{"name":"AP\u2010HP, H\u00f4pital de la Piti\u00e9\u2010Salp\u00eatri\u00e8re, Department of Metabolic Biochemistry, Universit\u00e9 Paris Cit\u00e9, Facult\u00e9 de Pharmacie  Paris 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