1
|
Singla L, Shah M, Moore-Hill D, Rosenquist P, Alfredo Garcia K. Electroconvulsive therapy for super refractory status epilepticus in pregnancy: case report and review of literature. Int J Neurosci 2023; 133:1109-1119. [PMID: 35287528 DOI: 10.1080/00207454.2022.2050371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We aim to describe use of electroconvulsive therapy (ECT) to treat super refractory status epilepticus (SRSE) in pregnancy and review the literature regarding utility and safety of ECT in refractory status epilepticus. BACKGROUND Status epilepticus (SE) is a commonly encountered emergency in neuro-critical care world. Pharmacotherapy of status epilepticus in pregnancy is very challenging given the effect of the majority of antiepileptic drugs (AEDs) on fetal development. Although there has been growing evidence for use of ECT in status epilepticus, data about its utility in pregnancy is lacking. DESIGN/METHOD A twenty-one year old Caucasian female with history of epilepsy presented at 8 weeks of gestation as status epilepticus (SE) after abrupt discontinuation of her AEDs. Treatment was initiated with standard regimen of benzodiazepine and levetiracetam, which was progressively expanded to include approximately 10 anti-epileptic drugs over the course of 30 days. The status epilepticus was super refractory to sedation. She underwent ECT on day 31 with remarkable improvement in electroencephalogram (EEG) pattern and resolution of status epilepticus following a single ECT session. We reviewed PubMed and collated case reports involving the use of ECT in status epilepticus with emphasis on differences in various confounding factors esp. etiology of status and age group. CONCLUSION Our case is the first reported case of ECT for successful treatment of SRSE in pregnancy. While majority AEDs pose a significant maternal and fetal risk during pregnancy, ECT could be a potential frontline therapy for SE in pregnancy.
Collapse
Affiliation(s)
- Laveena Singla
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Manan Shah
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Debra Moore-Hill
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Peter Rosenquist
- Department of Psychiatry, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Klepper Alfredo Garcia
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| |
Collapse
|
2
|
Stavropoulos I, Pak HL, Valentin A. Neuromodulation in Super-refractory Status Epilepticus. J Clin Neurophysiol 2021; 38:494-502. [PMID: 34261110 DOI: 10.1097/wnp.0000000000000710] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SUMMARY Status epilepticus (SE) is a severe condition that needs immediate pharmacological treatment to tackle brain damage and related side effects. In approximately 20% of cases, the standard treatment for SE does not control seizures, and the condition evolves to refractory SE. If refractory status epilepticus lasts more than 24 hours despite the use of anesthetic treatment, the condition is redefined as super-refractory SE (srSE). sRSE is a destructive condition, potentially to cause severe brain damage. In this review, we discuss the clinical neuromodulation techniques for controlling srSE when conventional treatments have failed: electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation, and deep brain stimulation. Data show that neuromodulation therapies can abort srSE in >80% of patients. However, no randomized, prospective, and controlled trials have been completed, and data are provided only by retrospective small case series and case reports with obvious inclination to publication bias. There is a need for further investigation into the use of neuromodulation techniques as an early treatment of srSE and to address whether an earlier intervention can prevent long-term complications.
Collapse
Affiliation(s)
- Ioannis Stavropoulos
- Department of Clinical Neurophysiology, King's College Hospital, London, United Kingdom
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; and
| | - Ho Lim Pak
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Antonio Valentin
- Department of Clinical Neurophysiology, King's College Hospital, London, United Kingdom
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; and
| |
Collapse
|
3
|
Kirmani BF, Au K, Ayari L, John M, Shetty P, Delorenzo RJ. Super-Refractory Status Epilepticus: Prognosis and Recent Advances in Management. Aging Dis 2021; 12:1097-1119. [PMID: 34221552 PMCID: PMC8219503 DOI: 10.14336/ad.2021.0302] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Super-refractory status epilepticus (SRSE) is a life-threatening neurological emergency with high morbidity and mortality. It is defined as “status epilepticus (SE) that continues or recurs 24 hours or more after the onset of anesthesia, including those cases in which SE recurs on the reduction or withdrawal of anesthesia.” This condition is resistant to normal protocols used in the treatment of status epilepticus and exposes patients to increased risks of neuronal death, neuronal injury, and disruption of neuronal networks if not treated in a timely manner. It is mainly seen in patients with severe acute onset brain injury or presentation of new-onset refractory status epilepticus (NORSE). The mortality, neurological deficits, and functional impairments are significant depending on the duration of status epilepticus and the resultant brain damage. Research is underway to find the cure for this devastating neurological condition. In this review, we will discuss the wide range of therapies used in the management of SRSE, provide suggestions regarding its treatment, and comment on future directions. The therapies evaluated include traditional and alternative anesthetic agents with antiepileptic agents. The other emerging therapies include hypothermia, steroids, immunosuppressive agents, electrical and magnetic stimulation therapies, emergent respective epilepsy surgery, the ketogenic diet, pyridoxine infusion, cerebrospinal fluid drainage, and magnesium infusion. To date, there is a lack of robust published data regarding the safety and effectiveness of various therapies, and there continues to be a need for large randomized multicenter trials comparing newer therapies to treat this refractory condition.
Collapse
Affiliation(s)
- Batool F Kirmani
- 1Texas A&M University College of Medicine, College Station, TX, USA.,3Epilepsy and Functional Neurosurgery Program, Department of Neurology, CHI St. Joseph Health, Bryan, TX, USA
| | - Katherine Au
- 2George Washington University, School of Medicine & Health Sciences, Washington DC, USA
| | - Lena Ayari
- 1Texas A&M University College of Medicine, College Station, TX, USA
| | - Marita John
- 1Texas A&M University College of Medicine, College Station, TX, USA
| | - Padmashri Shetty
- 4M. S. Ramaiah Medical College, M. S. Ramaiah Nagar, Bengaluru, Karnataka, India
| | - Robert J Delorenzo
- 5Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond, VA
| |
Collapse
|
4
|
Seymour J. Commentary and Update on the Contribution of the GABA Hypothesis to Understanding the Mechanism of Action of Electroconvulsive Therapy. J ECT 2021; 37:4-9. [PMID: 32826706 DOI: 10.1097/yct.0000000000000711] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Jeremy Seymour
- From the Cherry Tree Court, Tickhill Road Site, Balby Doncaster DN4 8QN, United Kingdom
| |
Collapse
|
5
|
Yuan F, Lu A, Wu S, Wang L. Refractory Status Epilepticus Responsive to Electroacupuncture at Shuigou Acupoint: A Case Report. Front Neurol 2020; 11:580777. [PMID: 33329323 PMCID: PMC7734353 DOI: 10.3389/fneur.2020.580777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022] Open
Abstract
Refractory status epilepticus (RSE) is a critical and intractable neurological emergency. Around 55% of RSE episodes still persist despite high dose of continuous infusion of anesthetics. It's a clinical urgency and challenge to search for novel alternative treatments to control RSE as soon as possible. Here, we reported a case of RSE in a 67-year-old woman with varicella-zoster virus encephalitis. She had persistent non-convulsive SE despite the continuous infusion of midazolam. On the basis of fundamental treatments, she was given electroacupuncture at Shuigou acupoint for 10 min. An immediate EEG suppression was seen after the electroacupuncture treatment and lasted for 9 min, and lasting epileptic discharges (> 10 s) and clinical seizures were not observed any more. Midazolam was withdrawn gradually 24 h later. This case report may bring an alternative treatment for RSE.
Collapse
Affiliation(s)
- Fang Yuan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Aili Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shibiao Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lixin Wang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
6
|
García-López B, Gómez-Menéndez AI, Vázquez-Sánchez F, Pérez-Cabo E, Isidro-Mesas F, Zabalegui-Pérez A, Muñoz-Siscart I, Lloria-Gil MC, Soto-Cámara R, González-Bernal JJ, González-Santos J, Aguilar-Parra JM, Trigueros R, López-Liria R, Kjær TW. Electroconvulsive Therapy in Super Refractory Status Epilepticus: Case Series with a Defined Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4023. [PMID: 32516983 PMCID: PMC7312395 DOI: 10.3390/ijerph17114023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
Super-refractory status epilepticus (SRSE) represents a neurological emergency that is characterized by a lack of response to the third line of antiepileptic treatment, including intravenous general anesthetics. It is a medical challenge with high morbidity and mortality. Electroconvulsive therapy (ECT) has been recommended as a nonpharmacologic option of treatment after other alternatives are unsuccessful. Its effect on the cessation of SRSE has been minimally investigated. The objective of this article is to analyze the effect of ECT on SRSE. For this purpose, a multidisciplinary team created a protocol based on clinical guidelines similar to those described previously by Ray et al. (2017). ECT was applied to six patients with SRSE after the failure of antiepileptic treatment and pharmacologic coma.The objective of each ECT session was to elicit a motor seizure for at least 20 s. SRSE was resolved in all patients after several days of treatment, including ECT as a therapy, without relevant adverse effects. Thus, ECT is an effective and feasible option in the treatment of SRSE, and its place in the algorithm in treatment should be studied due to the uncommon adverse effects and the noninvasive character of the therapy.
Collapse
Affiliation(s)
- Beatriz García-López
- Neurophysiology Department, Burgos University Hospital, 09006 Burgos, Spain; (B.G.-L.); (A.I.G.-M.); (F.I.-M.); (M.C.L.-G.)
| | - Ana Isabel Gómez-Menéndez
- Neurophysiology Department, Burgos University Hospital, 09006 Burgos, Spain; (B.G.-L.); (A.I.G.-M.); (F.I.-M.); (M.C.L.-G.)
| | | | - Eva Pérez-Cabo
- Intensive Care Unit, Burgos University Hospital, 09006 Burgos, Spain; (E.P.-C.); (A.Z.-P.)
| | - Francisco Isidro-Mesas
- Neurophysiology Department, Burgos University Hospital, 09006 Burgos, Spain; (B.G.-L.); (A.I.G.-M.); (F.I.-M.); (M.C.L.-G.)
| | - Arturo Zabalegui-Pérez
- Intensive Care Unit, Burgos University Hospital, 09006 Burgos, Spain; (E.P.-C.); (A.Z.-P.)
| | | | - María Carmen Lloria-Gil
- Neurophysiology Department, Burgos University Hospital, 09006 Burgos, Spain; (B.G.-L.); (A.I.G.-M.); (F.I.-M.); (M.C.L.-G.)
| | - Raúl Soto-Cámara
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain
| | | | | | - José M. Aguilar-Parra
- Department of Psychology, Health Research Centre, University of Almeria, 04120 Almeria, Spain; (J.M.A.-P.); (R.T.)
| | - Rubén Trigueros
- Department of Psychology, Health Research Centre, University of Almeria, 04120 Almeria, Spain; (J.M.A.-P.); (R.T.)
| | - Remedios López-Liria
- Department of Nursing, Physiotherapy and Medicine, Health Research Centre, University of Almería, 04120 Almeria, Spain;
| | | |
Collapse
|
7
|
San-Juan D, Dávila-Rodríguez DO, Jiménez CR, González MS, Carranza SM, Hernández Mendoza JR, Anschel DJ. Neuromodulation techniques for status epilepticus: A review. Brain Stimul 2019; 12:835-844. [PMID: 31053521 DOI: 10.1016/j.brs.2019.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 04/05/2019] [Accepted: 04/14/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT), Vagal Nerve Stimulation (VNS), Transcranial Magnetic Stimulation (TMS) and Deep Brain Stimulation (DBS) are neuromodulation therapies that have been used to treat Status Epilepticus (SE). OBJECTIVE Review the literature about the efficacy and safety of neuromodulation therapies in SE in humans. METHODS We searched studies in PubMed, Scopus, Google Scholar and Science Direct (inception to June 2018). Four review authors independently selected the studies, extracted data and assessed the methodological quality of the studies using the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions, PRISMA guidelines, Oxford and GRADE scales, and Murad et al., 2018 methodological quality and synthesis of case series and case reports. RESULTS We analyzed 27 articles (45 patients) with 4 different neuromodulation therapies. In ECT we found 80% rate of disruption of SE and 5% of adverse events was reported. Using iVNS 15/16 (93.7%) patients resolved the SE. All patients who underwent TMS and DBS aborted SE, however, 50% of patients with DBS had severe adverse events. CONCLUSIONS Case series and case reports suggest that neuromodulation therapies can abort SE in 80-100% of patients (Oxford scale and GRADE were level 4 and D) with a wide range of adverse effects, which claims for prospective studies on the relationship be-tween efficacy and safety.
Collapse
Affiliation(s)
- Daniel San-Juan
- Neurophysiology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico.
| | | | - Christian Ramos Jiménez
- Faculty of Medicine, Autonomous University of State of Mexico, Toluca de Lerdo, State of Mexico, Mexico
| | | | | | - Jesús Ricardo Hernández Mendoza
- Faculty of Medicine Mexicali, Autonomous University of Baja California, Dr. Humberto Torres Sangines, Mexicali, Baja California, Mexico
| | - David J Anschel
- Comprehensive Epilepsy Center of Long Island, Port Jefferson, NY, USA
| |
Collapse
|
8
|
Surya S, Bishnoi R, Rosenquist PB, McCall WV. Uses of Electroconvulsive Therapy in Conditions Other than Major Depressive Episode. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20190314-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
9
|
Moshé SL, Galanopoulou AS. Commentary on Schotte et al. "Development of temporal lobe epilepsy during maintenance electroconvulsive therapy: A case of human kindling?". Epilepsia Open 2019; 4:206-209. [PMID: 30868133 PMCID: PMC6398154 DOI: 10.1002/epi4.12296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/18/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Solomon L. Moshé
- Saul R. Korey Department of NeurologyIsabelle Rapin Division of Child NeurologyDominick P. Purpura Department of NeuroscienceLaboratory of Developmental EpilepsyAlbert Einstein College of MedicineEinstein/Montefiore Epilepsy CenterMontefiore Medical CenterBronxNew York
- Department of PediatricsAlbert Einstein College of MedicineEinstein/Montefiore Epilepsy CenterMontefiore Medical CenterBronxNew York
| | - Aristea S. Galanopoulou
- Saul R. Korey Department of NeurologyIsabelle Rapin Division of Child NeurologyDominick P. Purpura Department of NeuroscienceLaboratory of Developmental EpilepsyAlbert Einstein College of MedicineEinstein/Montefiore Epilepsy CenterMontefiore Medical CenterBronxNew York
| |
Collapse
|