Refractory status epilepticus: electroconvulsive therapy as a possible therapeutic strategy

Area of Science:

• Neurology
• Neuroscience
• Critical Care Medicine

Background:

• Refractory status epilepticus (SE) presents a significant daily therapeutic challenge in clinical practice.
• Electroconvulsive therapy (ECT) is established for psychiatric disorders and known to elevate the seizure threshold.

Observation:

• A review identified eight case reports on ECT use in refractory SE.
• No placebo-controlled or open-label studies have been published regarding ECT's efficacy or safety in refractory SE.
• Significant heterogeneity exists in the ECT parameters utilized across reported cases.

Findings:

• ECT demonstrated SE cessation in 80% of the reported cases.
• Complete patient recovery was achieved in 27% of cases.
• Common features across case reports suggest potential recommendations for ECT administration in refractory SE.

Implications:

• ECT may represent a viable therapeutic option for severe, treatment-resistant SE, especially after failed anesthetic coma inductions.
• The findings underscore the critical need for rigorous clinical trials to validate the efficacy and safety of ECT for refractory SE.
• Establishing ECT as a standard treatment for refractory SE could improve outcomes for patients with limited therapeutic alternatives.