Electroconvulsive therapy for refractory status epilepticus: A systematic review

Area of Science:

• Neurology
• Neurosurgery
• Neuroscience

Background:

• Refractory status epilepticus (RSE) presents a significant clinical challenge.
• Electroconvulsive therapy (ECT) is a potential treatment option for RSE.
• A comprehensive review of existing literature is needed to assess ECT's efficacy in RSE.

Purpose of the Study:

• To conduct a systematic literature review on the use of electroconvulsive therapy (ECT) for refractory status epilepticus (RSE).
• To evaluate the evidence strength and clinical outcomes associated with ECT in RSE patients.

Main Methods:

• Systematic search of multiple databases (MEDLINE, EMBASE, Scopus, etc.) and clinical trial registries.
• Inclusion of 14 original articles detailing 19 RSE patients treated with ECT.
• Evidence strength adjudicated using Oxford and GRADE methodologies by two independent reviewers.

Main Results:

• ECT application resulted in seizure reduction or control in 11 out of 19 patients (57.9%).
• Complete seizure control was observed in 36.8% of patients, with partial response in 21.0%.
• Functional outcomes were poor, with 10 of 13 assessable patients categorized as dead or severely disabled; evidence was Oxford level 4, GRADE D.

Conclusions:

• Limited evidence (Oxford level 4, GRADE D) suggests ECT may improve seizure control in RSE.
• Routine use of ECT for RSE is not currently recommended.
• Further prospective studies are necessary to definitively establish ECT's efficacy for RSE.