Targeted Electroconvulsive Therapy for Super Refractory Status Epilepticus: A Case Report and Literature Review

Abstract

Background Consultation psychiatrists may be asked by neurological services to identify treatment options for status epilepticus (SE), particularly electroconvulsive therapy (ECT). The successful use of ECT in the treatment of refractory SE has been reported in numerous case studies but remains sparsely utilized despite its apparent efficacy. Methods We present a case of a patient who received ECT for SE, fifty-one days after extensive pharmacologic treatment failed. We then review theories of ECT anticonvulsant effects and suggest approaches to further study and treatment. Results A 51 year-old man developed epilepsia partialis continua refractory to anticonvulsant medications. ECT was implemented through coordination with multiple hospital services. Transient worsening of the epileptic focus, accompanied by a distinct change in seizure pattern, was captured on electroencephalography (EEG) after ECT. Cessation of the status and marked functional improvement eventually followed. Discussion Although multiple case reports detail ECT used in SE, its effectiveness is difficult to ascertain. A novel aspect of our case is individualized electrode placement to target the epileptic focus. ECT may reset the neurotransmitter balance, induce trophic changes, or alter cerebral blood flow and metabolism in ways that promote neuronal stabilization. Earlier use of ECT, optimal electrode placement, and the anticonvulsant mechanisms of effect all require further research. Conclusions ECT for the treatment of SE may be safely and effectively used when pharmacologic treatment fails. Consultation psychiatrists should be aware of the evidence supporting ECT in SE so that they may recommend its use and apply necessary modifications to the treatment protocol.