6th Edition of Neurology World Conference 2026

Abstract

Super-refractory status epilepticus (SRSE) is a life-threatening condition in which seizures continue despite aggressive medical treatment. Autoimmune encephalitis is a recognized cause of SRSE, but its diagnosis can be difficult when routine cerebrospinal fluid studies and autoimmune antibody tests come out to be negative. This often delays immunotherapy and prolongs critical illness. Case Presentation We report the case of a patient with a known history of epilepsy who developed prolonged generalized seizures progressing to super-refractory status epilepticus. The patient required admission to the intensive care unit, endotracheal intubation, and prolonged mechanical ventilation due to refractory seizure activity. Investigations Continuous electroencephalography demonstrated persistent epileptiform activity with generalized periodic discharges. Extensive diagnostic evaluation for infectious, metabolic, and structural causes was unremarkable. Cerebrospinal fluid analysis revealed no evidence of infection or inflammation, and both serum and cerebrospinal fluid autoimmune antibody panels were negative. Management The patient was treated with multiple antiseizure medications and anesthetic agents, including benzodiazepines, levetiracetam, valproic acid, lacosamide, ketamine, and induction of barbiturate coma. Despite maximal conventional therapy, seizures recurred with attempts at sedation weaning. Given the clinical course, EEG findings, and exclusion of alternative etiologies, antibody-negative probable autoimmune encephalitis was suspected. High-dose intravenous corticosteroids were initiated, followed by intravenous immunoglobulin therapy. Outcome and Follow-up Following immunotherapy, seizure activity resolved, enabling successful weaning of anesthetic agents and extubation after a prolonged intensive care stay. The patient demonstrated meaningful neurological improvement and was transferred out of the intensive care unit. After hospital discharge, seizure recurrence occurred but was subsequently controlled with an increased dose of valproate and continuation of immunotherapy, supporting an ongoing immune-mediated process. Conclusion This case illustrates that autoimmune encephalitis should be considered in patients with super-refractory status epilepticus even when antibody testing is negative. It highlights the importance of clinical judgment and early empiric immunotherapy in selected cases, which may lead to seizure control and improved outcomes when standard treatments fail.