Electroconvulsive therapy for super refractory status epilepticus: A scoping review

Area of Science:

• Neurology
• Neuroscience
• Critical Care Medicine

Background:

• Status epilepticus (SE) is a neurological emergency with limited evidence-based treatments for refractory (RSE) and super refractory (SRSE) forms.
• Electroconvulsive therapy (ECT) is a recognized treatment for psychiatric disorders, with emerging reports on its use in SRSE.

Purpose of the Study:

• To conduct a scoping review on the current knowledge of electroconvulsive therapy (ECT) safety and efficacy in treating super refractory status epilepticus (SRSE).
• To analyze ECT's effectiveness in aborting SRSE across adult and pediatric populations.

Main Methods:

• A scoping review following Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines.
• Systematic database searches and independent appraisal of peer-reviewed studies involving ECT for SRSE.
• Data extraction on patient demographics, ECT protocols, and clinical outcomes.

Main Results:

• Analysis of 16 studies involving 40 patients (adult and pediatric) with SRSE treated with ECT.
• High seizure abortion rates: 80% in adults and 100% in pediatric patients.
• One ECT-related adverse event reported; common outcomes included seizure recurrence, new epilepsy, technology dependence, and death.

Conclusions:

• Differences in adult and pediatric outcomes may stem from logistical/regulatory barriers in intensive care units (ICUs).
• Prospective, randomized controlled trials are essential to fully evaluate ECT's risk-benefit profile for SRSE compared to alternative treatments.