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An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
A 23-year-old man exhibited lack of response during off-label treatment with immune globulin, methylprednisolone and tocilizumab for SARS-CoV-2 infection [not all routes stated; dosages not stated].
The man, who had a family history of epileptic encephalopathy in a cousin, presented with refractory convulsive status epilepticus (SE) that were preceded by febrile episodes. He therefore required unspecified non-barbituric sedation and was admitted to the ICU. He was diagnosed with nosocomial SARS-CoV-2 infection. He experienced torpid evolution with persistent fever and seizures, while he had been receiving unspecified anti-seizure drugs and unspecified barbituric sedation. He received off-label therapy with methylprednisolone, IV immune globulin [IVIG] and tocilizumab for SARS-CoV-2 infection, in addition to plasma exchange, without any response.
The man was noted to have new-onset refractory status epilepticus, for which he started receiving anakinra. Dramatic improvement was subsequently observed, and sedation was withdrawn. Anakinra was stopped after 4 weeks because of neutropenia [aetiology unknown]. He showed a positive yet incomplete response to anakinra. At the time of the report, he was in the ICU for the third month and being treated by valproate, zonisamide, brivaracetam, perampanel, cannabidiol and ketogenic diet.
Reference
- Palacios Mendoza M, et al. Anakinra in the treatment of new-onset refractory status epilepticus: Our experience from a clinical case. European Journal of Neurology 28 (Suppl. 1): 699 (plus poster) abstr. EPO-410, Jun 2021. Available from: URL: https://onlinelibrary.wiley.com/doi/10.1111/ene.14975 [abstract]