Electroconvulsive therapy for super refractory status epilepticus: A scoping review

Status epilepticus (SE) is a neurologic emergency. Although evidence-based treatments exist for SE, treatment of refractory status epilepticus (RSE) and super refractory status epilepticus (SRSE) lacks evidence. Electroconvulsive therapy (ECT) is safe and efficacious when used to treat psychiatric disorders. Seizure control attributed to ECT in the setting of SRSE has been reported in case reports and case series. The objective of this scoping review was to understand the current knowledge regarding the safety and efficacy of ECT in aborting SRSE in the adult and pediatric populations.

This scoping review was designed based on guidelines from the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Databases were searched to identify relevant studies, which were independently appraised by reviewers. Peer-reviewed studies with focus on patients who were treated with ECT for SRSE were included. Patient demographic, ECT course, and clinical outcome data were collated in a prespecified proforma.

Data were extracted from 16 studies, which included a combined 40 patients. Ages were unknown for eight patients. Of the patients whose ages were known, more pediatric patients than adults were previously healthy, and seizure etiology differed between these two subgroups. SE was aborted in 80% of adult and 100% of pediatric patients. One adverse effect related to ECT was reported. Seizure recurrence, new epilepsy diagnoses, technology dependence, and death were common.

Differences between adult and pediatric patients who are treated with electroconvulsive therapy (ECT) for SRSE could reflect a combination of factors, including logistical and regulatory barriers that limit use of ECT in intensive care units (ICUs). Prospective, randomized controlled trials are needed to fully understand the risks vs benefits of ECT for SRSE compared to other treatments.