Dirençli Status Epileptikusun Nadir Bir Etyolojisi: Stiff Person Sendromu
Özet
Dirençli status epileptikus, yoğun bakım ünitelerinde yüksek mortalite ve morbiditeye yol açabilen kritik bir nörolojik acildir. Bu yazıda, epilepsi ve psikojenik non-epileptik nöbet öyküsü olan 26 yaşındaki kadın hasta, status epileptikus ve çoklu organ yetmezliği tablosu ile sunulmaktadır. Yoğun bakım sürecinde standart antiepileptik tedavilere yanıt alınamamış, immünolojik ve enfeksiyöz araştırmalar genişletilmiş ve plazmaferez ile sitokin adsorpsiyon tedavisi uygulanmıştır. Tedavi sürecinde yüksek titrede anti-glutamik asit dekarboksilaz (GAD) antikoru (>2000 IU/ml) saptanması üzerine Stiff Person Sendromu (SPS) tanısı konulmuş, benzodiazepin ve baklofen tedavisi ile semptomatik kontrol sağlanmış ve immünomodülatör tedaviler (Rituksimab, plazmaferez) eklenmiştir. Bu olgu, dirençli status epileptikusun nadir fakat önemli etiyolojilerinden biri olan SPS’ye dikkat çekmekte, tanı ve tedavi sürecinde multidisipliner yaklaşımın önemini vurgulamaktadır.
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