New onset refractory status epilepticus diagnosed in the second trimester: A case report

New-onset refractory status epilepticus (NORSE) is a rare condition in which a previously healthy individual develops refractory seizures without an identifiable cause. In pregnancy, management is particularly challenging due to the need to control seizures while minimizing teratogenic risk for the fetus. We report a 22-year-old woman who developed NORSE at 19 weeks’ gestation following recurrent tonic-clonic seizures. Treatment included multiple antiseizure medications: levetiracetam, oxcarbazepine, lacosamide, clobazam, and lamotrigine. Due to super-refractory status, she required intubation and sedation with propofol and midazolam and was extubated once seizure-free. Following a breakthrough seizure and suicide attempt, levetiracetam was replaced with brivaracetam. Fetal growth and biophysical profile remained appropriate on serial surveillance. She underwent term induction of labor, delivering a healthy neonate without signs of withdrawal. This is the first reported case of second-trimester NORSE with favorable perinatal outcomes, underscoring the need for a multidisciplinary approach to balance seizure control and fetal safety.