ECT For Status Epilepticus: Another Review

 Out on PubMed, from authors in Malayasia and Austria, is this review:

Electroconvulsive Therapy in Refractory and Super-Refractory Status Epilepticus in Adults: A Scoping Review.

Ong MJY, Lee VLL, Teo SL, Tan HJ, Trinka E, Khoo CS.Neurocrit Care. 2024 May 20. doi: 10.1007/s12028-024-02003-4. Online ahead of print.PMID: 38769254 Review.
The abstract is copied below:

Background: Electroconvulsive therapy (ECT) has been suggested as a treatment option for refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE).

Objective: The objective of this scoping review was to conduct an extensive literature review on the role of ECT as a treatment option for RSE and SRSE.

Methods: We searched Ovid MEDLINE and Scopus for journal articles from database inception until February 2024. Articles were then selected based on predetermined inclusion and exclusion criteria.

Results: We identified five retrospective case series with 28 adult patients receiving ECT for RSE or SRSE. ECT was administered within 3-70 days (mean 20 days) after the development of SE, and the mean number of ECT courses ranged from 1 to 12 sessions for each patient. ECT was administered in fixed or titrated doses. A total of 20 out of 28 patients (71%) showed clinical improvement, with two (7%) having complete cessation of seizures. It is essential to note that given the lack of control, there could be overreporting of clinical improvement in these studies. 11 patients (39%) were reported as deceased due to causes that were not directly related to ECT treatment. Four patients (14%) reported adverse effects of ECT, including memory, concentration, and/or cognitive impairment.

Conclusions: There are level-4 Oxford Centre for Evidence-Based Medicine evidence and low-level Grading of Recommendations Assessment Development and Education evidence that suggest ECT as a treatment option for RSE and SRSE. In light of the limitations of the existing evidence, clinicians should carefully consider individual patients' clinical contexts when deciding on the appropriateness of ECT as a treatment option. Further research, including prospective studies with controlled designs, is needed to elucidate the efficacy, safety, and optimal regime of ECT in the management of RSE and SRSE.

Keywords: Electroconvulsive therapy; Epilepsy; Status epilepticus.

The review is here.
And from the text:






This is a well-presented review of an "orphan" indication for ECT, and definitely worth reading. The conclusions are reasonable, given the small size of the case report literature.
But the discussion of memory effects of ECT in this population is akin to a discussion of the arrangement of the deck chairs on the Titanic, instead of maximizing the use of lifeboats...

The related issue of prolonged seizures in ECT for standard psychiatric indications is worth mentioning. I believe a definition of "prolonged" should be two minutes, not three. 

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