ECT For Super Refractory Status Epilepticus: New Case Series From Maryland

Out on PubMed, from investigators in Maryland, is this case series:

Evaluating salvage electroconvulsive therapy for the treatment of prolonged super refractory status epilepticus: A case series.

Woodward MR, Doddi S, Marano C, Regenold W, Pritchard J, Chen S, Margiotta M, Chang WW, Alkhachroum A, Morris NA.Epilepsy Behav. 2023 Jun 3;144:109286. doi: 10.1016/j.yebeh.2023.109286. Online ahead of print.PMID: 37276802


The abstract is copied below:

Background and objectives: Clinicians have treated super refractory status epilepticus (SRSE) with electroconvulsive therapy (ECT); however, data supporting the practice are scant and lack rigorous evaluation of continuous electroencephalogram (cEEG) changes related to therapy. This study aims to describe a series of patients with SRSE treated at our institution with ECT and characterize cEEG changes using a blinded review process.

Methods: We performed a single-center retrospective study of consecutive patients admitted for SRSE and treated with ECT from January 2014 to December 2022. Our primary outcome was the resolution of SRSE. Secondary outcomes included changes in ictal-interictal EEG patterns, anesthetic burden, treatment-associated adverse events, and changes in clinical examination. cEEG was reviewed pre- and post-ECT by blinded epileptologists.

Results: Ten patients underwent treatment with ECT across 11 admissions (8 female, median age 57 years). At the time of ECT initiation, nine patients had ongoing SRSE while two had highly ictal patterns and persistent encephalopathy following anesthetic wean, consistent with late-stage SRSE. Super-refractory status epilepticus resolution occurred with a median time to cessation of 4 days (interquartile range [IQR]: 3-9 days) following ECT initiation. Background continuity improved in five patients and periodic discharge frequency decreased in six. There was a decrease in anesthetic use following the completion of ECT and an improvement in neurological exams. There were no associated adverse events.

Discussion: In our cohort, ECT was associated with improvement of ictal-interictal patterns on EEG, and resolution of SRSE, and was not associated with serious adverse events. Further controlled studies are needed.

Keywords: Anti-seizure therapy; Electroconvulsive therapy; Electroencephalography; Status epilepticus; Super refractory status epilepticus.

While I do not have access to the full article, the above abstract is instructive.
ECT as an anti-seizure therapy in status epilepticus is one of the most interesting neurological indications for ECT.
If a blog reader with full access would like to provide details of how the patients did, that would be most welcome, thanks.


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