Author response: New onset refractory status epilepticus research: What is on the horizon?

We thank Dr. Sethi for the comment on our Contemporary Issues article.1 There are currently no guidelines and early immunotherapy may be indicated for patients with biomarkers or risk factors for autoimmunity (e.g., extreme delta with or without brushes, suggestive of anti-NMDA receptor antibody encephalitis,2 a personal or family history of autoimmunity), or tumors that are known to be associated with autoimmune encephalitis.3 There are limited data to date, and the decision to treat with immunomodulatory treatments is ultimately a clinical one pending further research. Any patient without a clear etiology for NORSE within the first 72 hours of presentation and without a clear contraindication to immunosuppression warrants careful consideration for treatment with immunotherapy. Current evidence suggests that earlier treatment is associated with better clinical outcomes.4 This comment may also draw further attention to the current autoantibody testing limitations; we hope that improved and faster testing may become available.

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