ECT for Status Epilepticus: Mention in German Society for Neurology Guidelines

[S2k guidelines: status epilepticus in adulthood : Guidelines of the German Society for Neurology].

Rosenow F, Weber J; Deutsche Gesellschaft für Neurologie (DGN); Österreichische Gesellschaft für Neurologie (ÖGN).Nervenarzt. 2021 Mar 22. doi: 10.1007/s00115-020-01036-2. Online ahead of print.PMID: 33751150 Review. German.

The abstract is copied below:

in English, German
This S2k guideline on diagnosis and treatment of status epilepticus (SE) in adults is based on the last published version from 2021. New definitions and evidence were included in the guideline and the clinical pathway. A seizures lasting longer than 5 minutes (or ≥ 2 seizures over more than 5 mins without intermittend recovery to the preictal neurological state. Initial diagnosis should include a cCT or, if possible, an MRI. The EEG is highly relevant for diagnosis and treatment-monitoring of non-convulsive SE and for the exclusion or diagnosis of psychogenic non-epileptic seizures. As the increasing evidence supports the relevance of inflammatory comorbidities (e.g. pneumonia) related clinical chemistry should be obtained and repeated over the course of a SE treatment, and antibiotic therapy initiated if indicated.Treatment is applied on four levels: 1. Initial SE: An adequate dose of benzodiazepine is given i.v., i.m., or i.n.; 2. Benzodiazepine-refractory SE: I.v. drugs of 1st choice are levetiracetam or valproate; 3. Refractory SE (RSE) or 4. Super-refractory SE (SRSE): I.v. propofol or midazolam alone or in combination or thiopental in anaesthetic doses are given. In focal non-convulsive RSE the induction of a therapeutic coma depends on the circumstances and is not mandatory. In SRSE the ketogenic diet should be given. I.v. ketamine or inhalative isoflorane can be considered. In selected cased electroconvulsive therapy or, if a resectable epileptogenic zone can be defined epilepsy surgery can be applied. I.v. allopregnanolone or systemic hypothermia should not be used.

Keywords: Diagnoses ICD-10 codes G41.0, G41.1, G41.2, G41.8, G41.9; Intravenous antiepileptics; Intubation anesthesia; Refractory status epilepticus; Seizure series; Status epilepticus.

and from the text:

[The below is treatment recommendation 29 out of 32]:

29

Electroconvulsive therapy can be considered in individual cases in patients with SRSE (strength of recommendation: open, strength of consensus: strong consensus).

The point of today's blog post is simply that ECT has made it into neurology guidelines in Germany as a treatment option for SRSE (super refractory status epilepticus). This is a very rare indication for ECT, but one that should be kept in mind as potentially life-saving. The more familiar our neurology colleagues are with ECT, the more likely they are to consider it in appropriate clinical situations, including this, and patients with Parkinson's Disease, not to mention referral of typical ECT candidates with severe depression.