Neuromodulation in Children With Super-Refractory Status Epilepticus: Review Includes ECT
Out on PubMed, from authors in the UK, is this review:
The abstract is copied below:
Status epilepticus (SE) is a life-threatening condition and medical emergency which can have lifelong consequences, including neuronal death and alteration of neuronal networks, resulting in long-term neurologic and cognitive deficits in children. When standard pharmacological treatment for SE is not successful in controlling seizures, the condition evolves to refractory SE (rSE) and finally to super-refractory SE (srSE) if it exceeds 24 h despite using anaesthetics. In this systematic review, we present literature data on the potential uses of clinical neuromodulation techniques for the management of srSE in children, including electroconvulsive therapy, vagus nerve stimulation, and deep brain stimulation. The evaluation of these techniques is limited by the small number of published paediatric cases (n = 25, one with two techniques) in peer-reviewed articles (n = 18). Although neuromodulation strategies have not been tested through randomised, prospective controlled clinical trials, this review presents the existing data and the potential benefits of neuromodulation therapy, suggesting that these techniques, when available, could be considered at earlier stages within the course of srSE intending to prevent long-term neurologic complications. Clinical trials aiming to establish whether early intervention can prevent long-term sequelae are necessary in order to establish the potential clinical value of neuromodulation techniques for the treatment of srSE in children.
Keywords: children epilepsy; deep brain stimulation; electroconvulsive therapy; neuromodulation; super-refractory status epilepticus; vagus nerve stimulation.
This is an interesting review with tiny "n"s. ECT's anticonvulsant properties continue to intrigue. ECT also seems much more applicable to emergency clinical situations than VNS or DBS, compared here. At least these authors recognize that ECT is "noninvasive", the other two not so much...
Neuromodulation Techniques in Children with Super-Refractory Status Epilepticus.
Brain Sci. 2023 Oct 30;13(11):1527. doi: 10.3390/brainsci13111527.PMID: 38002487Review.
Status epilepticus (SE) is a life-threatening condition and medical emergency which can have lifelong consequences, including neuronal death and alteration of neuronal networks, resulting in long-term neurologic and cognitive deficits in children. When standard pharmacological treatment for SE is not successful in controlling seizures, the condition evolves to refractory SE (rSE) and finally to super-refractory SE (srSE) if it exceeds 24 h despite using anaesthetics. In this systematic review, we present literature data on the potential uses of clinical neuromodulation techniques for the management of srSE in children, including electroconvulsive therapy, vagus nerve stimulation, and deep brain stimulation. The evaluation of these techniques is limited by the small number of published paediatric cases (n = 25, one with two techniques) in peer-reviewed articles (n = 18). Although neuromodulation strategies have not been tested through randomised, prospective controlled clinical trials, this review presents the existing data and the potential benefits of neuromodulation therapy, suggesting that these techniques, when available, could be considered at earlier stages within the course of srSE intending to prevent long-term neurologic complications. Clinical trials aiming to establish whether early intervention can prevent long-term sequelae are necessary in order to establish the potential clinical value of neuromodulation techniques for the treatment of srSE in children.
Keywords: children epilepsy; deep brain stimulation; electroconvulsive therapy; neuromodulation; super-refractory status epilepticus; vagus nerve stimulation.
The article is here.
And from the text:
This is an interesting review with tiny "n"s. ECT's anticonvulsant properties continue to intrigue. ECT also seems much more applicable to emergency clinical situations than VNS or DBS, compared here. At least these authors recognize that ECT is "noninvasive", the other two not so much...
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