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Journal Article
58 Toclizumab for RSE in those with or without pre-existing epilepsy – time for a trial?
2025
Overview
Refractory status epilepticus (RSE) is defined as prolonged or repeated seizures without recovery despite the initiation of at least two anti-seizure medications (ASMs). It is a neurological emergency, with potentially devasting short term consequences and significant risk of longer-term morbidity.Tocilizumab is a humanized monoclonal antibody against the IL-6 receptor, used primarily for rheumatological conditions and cytokine-release syndrome. It is thought to promote an anti-seizure effect for patients with status epilepticus via downregulation of IL-6, a component of the acute phase response. Tocilizumab has been successful in treating new onset refractory status epilepticus (NORSE) that has been refractory to other treatments, including rituximab, though has been associated with significant adverse events.We present five cases of RSE, including two with a pre-existing history of seizures. Toclizumab administered within 18 days of presentation (8mg/kg, second dose after 4 weeks) terminated status in four cases, longer term outcomes varied depending on the underlying aetiology.All patients were received steroids and a minimum of five ASMs in the context of sedation pre-Toclizumab. Plasma exchange had been given in four cases.There is a potential role for Toclizumab in the early treatment of RSE.asha.patel1@nhs.net
Publisher
BMJ Publishing Group LTD
Subject
