Electroconvulsive Therapy for Refractory Status Epilepticus: A Case Series

Status epilepticus is characterized by a prolonged, self-sustaining seizure or repeated seizures without return to baseline. The clinical manifestations of status epilepticus in children and adults range from overt generalized convulsions to more subtle behavioral manifestations, including unresponsiveness in the setting of the intensive care unit. Status epilepticus is the most common neurologic emergency of childhood. A large proportion of these episodes are the result of a prolonged febrile seizure or an acute symptomatic etiology. Fortunately, status epilepticus occurs without consequence for many children, but for others, it is correlated with long-term neurologic dysfunction or death. Treatment of status epilepticus should commence promptly upon its recognition, using predefined treatment protocols. The goal of treatment is the rapid termination of the seizure, to minimize the acute and chronic effects of this emergency and to allow for the prompt assessment and management of the underlying precipitant. Currently, the drug class of first choice in the in-hospital and out-of-hospital treatment of status epilepticus is the benzodiazepines, which may need to be quickly followed by a next-line agent, as the efficacy of the benzodiazepines is negatively correlated with seizure duration. Traditionally, these next-line agents have included phenobarbital and phenytoin, but emerging evidence supports the use of intravenous formulations of other antiepileptic drugs. If the first two agents fail, high-dose intravenous midazolam or anesthetic therapy should be rapidly initiated. This paper reviews the current treatment options and strategies for pediatric patients with status epilepticus.

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“…Standard procedure Electroconvulsive therapy (ECT) has been reported to successfully terminate SE in children and adults [49,50,Class IV].…”

Section: Electroconvulsive Therapymentioning

confidence: 99%

Treatment of Pediatric Status Epilepticus

Loddenkemper

Goodkin

2011

Curr Treat Options Neurol

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“…5,11 Since then, there have been other case reports or series reporting success of this therapy, both in adult and paediatric patients. 12,13 It is usually applied with the withdrawal of anticonvulsants or anaesthetics. Mechanisms suggested include enhanced gamma-aminobutyric acid inhibition, the effect of paradoxical stimulation of status epilepticus and electrical modulation.…”

Section: Discussionmentioning

confidence: 99%

Electroconvulsive therapy for new-onset super-refractory status epilepticus

Chan¹,

Lee²,

Koo³

et al. 2018

Hong Kong Med J

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“…ECT terminated seizures in two out of three adult patients with RSE of unknown etiology (two with cerebrospinal fluid pleocytosis) [68]. One had complete neurologic recovery; the other was left with mild cognitive impairment and epilepsy, but returned to independent living.…”

Section: Other Therapiesmentioning

confidence: 93%

Treatment of Refractory Status Epilepticus in Childhood

Schreiber

Gaillard

2010

Curr Neurol Neurosci Rep

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Refractory status epilepticus (RSE) is characterized by a prolonged seizure that persists despite adequate initial management. RSE accounts for almost one quarter of all status epilepticus and carries significant risk for morbidity and mortality. Treatment varies widely between institutions regarding medication choice, dose, and monitoring. Several agents including nonanesthetic antiepileptic drugs (AEDs), anesthetic AEDs, enteral AEDs, and other therapies have been used in RSE. We review the current treatment strategies for RSE, focusing on patient selection, monitoring, optimal dosing and administration of medications, efficacy, adverse effects, and treatment duration.

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Electroconvulsive Therapy for Refractory Status Epilepticus: A Case Series

Abstract: ECT may be an effective therapy for refractory status epilepticus and warrants further study for this indication.

Cited by 65 publications

References 13 publications

Treatment of Pediatric Status Epilepticus

Treatment of Pediatric Status Epilepticus

Electroconvulsive therapy for new-onset super-refractory status epilepticus

Treatment of Refractory Status Epilepticus in Childhood

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