Refractory status epilepticus: electroconvulsive therapy as a possible therapeutic strategy.
Seizure. 2012-11-01; 21(9): 661-664
DOI: 10.1016/j.seizure.2012.07.010
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Refractory status epilepticus (SE) is a current daily therapeutic challenge.
Electroconvulsive therapy (ECT), which is frequently used to treat psychiatric
disorders, is known to raise the seizure threshold. As such, ECT could be of
major interest in refractory SE. In this paper, we provide a brief overview of
ECT in refractory SE. Although no placebo-controlled or open-label study has been
published on the efficacy or safety of ECT in refractory SE, eight case reports
have been identified. SE cessation was obtained in 80% of cases, and complete
recovery was achieved in 27% of patients. Despite the heterogeneity of the ECT
parameters used in these articles, we identified some common features that may be
recommended for the use of ECT in refractory SE. ECT might be a viable
therapeutic strategy for the most resistant and severe cases of SE, particularly
after the failure of two inductions of anesthetic coma. This potential indication
highlights the urgent need for clinical trials that assess the usefulness of ECT
in refractory SE.