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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.
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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;
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Abstract
OBJECTIVES Super refractory status epilepticus (SRSE) is a stage beyond refractory status that requires general anesthesia as management. Electroconvulsive therapy (ECT) is recommended only as a potential treatment option beyond general anesthesia and after all other options have been exhausted. Its effect on aborting status has been minimally researched. We present the largest case series to our knowledge exploring the effect of ECT on SRSE. METHODS Eight adults hospitalized for SRSE received ECT in an attempt to abort status after other treatment modalities were exhausted. Electroconvulsive therapy consisted of a 504-mC (≈99.4 J) stimulus delivered bifrontotemporally with a constant 0.5-millisecond pulse width. Seizure activity during ECT was monitored visually and correlated to the single-channel recording provided by the apparatus. RESULTS There was neurotelemetry or clinical evidence of improvement within 24 hours after the full course of ECT treatment in 5 (63%) of the 8 cases. Cases that improved were given an average of 7.8 total ECT stimulations, eliciting an average of 4.2 total seizures. CONCLUSIONS Although it is difficult to determine the exact role of ECT in the improvement of 63% of our cases, we present a series of patients for whom pharmacotherapy, ketogenic diet, and general anesthesia otherwise did not produce an appreciable effect on status prior to implementation of ECT. These findings suggest that cases of SRSE may benefit from ECT administration.
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Wachtel LE, Dhossche DM, Kellner CH. When is electroconvulsive therapy appropriate for children and adolescents? Med Hypotheses 2011; 76:395-9. [DOI: 10.1016/j.mehy.2010.11.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 11/04/2010] [Indexed: 11/29/2022]
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Koong FJ, Chen WC. Maintaining electroconvulsive therapy for refractory epilepsy combined with psychotic symptoms. BMJ Case Rep 2010; 2010:2010/dec21_1/bcr1120092506. [PMID: 22802485 DOI: 10.1136/bcr.11.2009.2506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Electroconvulsive therapy (ECT) is an effective treatment for many psychiatric conditions. However, using ECT to treat epilepsy is controversial. We present this case of a patient who had epilepsy and combined psychiatric symptoms, including irritable mood, aggressiveness, refusal of food intake and non-cooperation with medical care. Her brain CT revealed massive brain lesions. After ECT, she became dramatically more cooperative, less aggressive and ate food and took her medication. In addition, no spontaneous seizure was noted after ECT. However, when we stopped ECT, the previous symptoms gradually reappeared. We therefore regularly administered ECT once or twice a week to maintain the patient's stable condition. We suggest that ECT may be considered for maintenance of the patient with epilepsy who is refractory or uncooperative to other treatment.
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