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Research paper

A tiered decisional framework for DEE-SWAS: from initial treatment to escalation

Tiered decisional framework for DEE-SWAS treatment, with explicit escalation steps: first-line ASMs and SWAS recognition, IV pulse corticosteroids and benzodiazepines at SWI thresholds, surgery in lesional cases, neuromodulation/IVIG/ketogenic in non-lesional refractory cases, and long-term cognitive/rehabilitation monitoring. Stratified by etiology and age of onset.

Indexed context

Perilli L, et al.

dee-swastreatment-algorithmescalation-frameworkdecisional-frameworkreview2026

Markdown path

content/research/papers/2026-perilli-tiered-decisional-framework.md

Findings

Tiered decisional framework for DEE-SWAS treatment, with explicit escalation steps: first-line ASMs and SWAS recognition, IV pulse corticosteroids and benzodiazepines at SWI thresholds, surgery in lesional cases, neuromodulation/IVIG/ketogenic in non-lesional refractory cases, and long-term cognitive/rehabilitation monitoring. Stratified by etiology and age of onset.

Why it may matter for Levi

Levi has moved through the first two tiers (IV pulse methylprednisolone with near-total electrographic resolution). Framework reinforces that the next tier, if SWAS recurs, is etiology-stratified escalation (sulthiame, IVIG, benzodiazepine course, KD consideration) rather than defaulting to repeated pulses. Companion to the Rao 2025 Practical Neurology review already in the corpus.

Paper text

Perilli et al. (2026) — Tiered decisional framework for DEE-SWAS

Source

  • 2026 review/framework paper. Full citation pending full-text access.

Why in corpus

Cited in the 2026 Manus AI DEE-SWAS review as one of several 2026 papers articulating a tiered/stepwise decisional framework for DEE-SWAS management — directly relevant to how Levi's next treatment escalations are sequenced.

Key findings

  • Proposes tiered approach to DEE-SWAS treatment, with explicit steps for:
    1. First-line ASMs and recognition of SWAS on sleep-preserved EEG.
    2. Escalation to IV pulse corticosteroids and/or benzodiazepines at SWI thresholds.
    3. Consideration of surgery in lesional cases; consideration of neuromodulation/IVIG/ketogenic in non-lesional refractory cases.
    4. Long-term cognitive outcome monitoring and rehabilitation planning.
  • Emphasizes that the decisional algorithm should be stratified by etiology (structural vs. genetic vs. unknown) and by age of onset.

Levi-relevant takeaways

  • Levi has already moved through the first two tiers (IV pulse methylprednisolone in March 2026 with near-total electrographic resolution at April 2026 UCSF EEG).
  • The framework reinforces that the next tier for Levi, should SWAS recur, is not automatically more steroid — etiology-stratified escalation (e.g., sulthiame, IVIG, benzodiazepine course, consideration of KD) should be considered explicitly rather than defaulting to repeated pulses.
  • Useful companion to the Rao 2025 Practical Neurology review already in the corpus — similar stepwise thinking, 2026-updated.
  • Action item: when full-text becomes available, extract the explicit algorithm and compare against Levi's current management plan.