RESUMEN
Management of new-onset refractory status epilepticus and the approach to burst suppression variable is often challenging. We present the unusual case of a previously healthy 18-year-old male with new-onset status epilepticus admitted to the neurologic intensive care unit for 70 days. Despite treatment with multiple anti-epileptic drugs in addition to IV anesthetics, burst suppression was initially unsustainable and the patient remained in super-refractory status epilepticus. Extensive evaluation revealed an underlying autoimmune-mediated etiology with positivity for glutamic acid decarboxylase-65 antibody. Clinical response with a goal of 1-2 bursts per screen on EEG monitor was eventually achieved after a course of rituximab and plasma exchange therapy as well as a 7-day barbiturate coma with a regimen of clobazam, lacosamide, Keppra, and oxcarbazepine followed by a slow taper of phenobarbital and the addition of fosphenytoin. Remarkably, the patient was subsequently discharged to a rehabilitation facility with complete neurologic recovery. We discuss treatment strategies for new-onset refractory status epilepticus and highlight the role of rapid initiation of burst suppression with high-dose IV anesthetics to ensure neuroprotection while the underlying etiology is addressed with immune-modulating therapy.
RESUMEN
Recent studies suggest that exposure to only one component of audiovisual events can lead to cross-modal cortical activation. However, it is not certain whether such crossmodal recruitment can occur in the absence of explicit conditioning, semantic factors, or long-term associations. A recent study demonstrated that crossmodal cortical recruitment can occur even after a brief exposure to bimodal stimuli without semantic association. In addition, the authors showed that the primary visual cortex is under such crossmodal influence. In the present study, we used molecular activity mapping of the immediate early gene zif268. We found that animals, which had previously been exposed to a combination of auditory and visual stimuli, showed increased number of active neurons in the primary visual cortex when presented with sounds alone. As previously implied, this crossmodal activation appears to be the result of implicit associations of the two stimuli, likely driven by their spatiotemporal characteristics; it was observed after a relatively short period of exposure (~45 min) and lasted for a relatively long period after the initial exposure (~1 day). These results suggest that the previously reported findings may be directly rooted in the increased activity of the neurons occupying the primary visual cortex.
