Singla Laveena, Shah Manan, Moore-Hill Debra, Rosenquist Peter, Alfredo Garcia Klepper
Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, USA.
Department of Psychiatry, Medical College of Georgia at Augusta University, Augusta, GA, USA.
Int J Neurosci. 2023 Dec;133(10):1109-1119. doi: 10.1080/00207454.2022.2050371. Epub 2022 Mar 14.
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.
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.
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.
我们旨在描述使用电惊厥疗法（ECT）治疗妊娠期超级难治性癫痫持续状态（SRSE），并回顾关于ECT在难治性癫痫持续状态中的效用和安全性的文献。
癫痫持续状态（SE）是神经重症监护领域常见的急症。鉴于大多数抗癫痫药物（AEDs）对胎儿发育的影响，妊娠期癫痫持续状态的药物治疗极具挑战性。尽管越来越多的证据表明ECT可用于癫痫持续状态，但缺乏其在妊娠期效用的数据。
设计/方法：一名21岁有癫痫病史的白人女性，在妊娠8周时因突然停用AEDs而出现癫痫持续状态（SE）。治疗开始采用苯二氮䓬类药物和左乙拉西坦的标准方案，并在30天内逐渐增加至约10种抗癫痫药物。癫痫持续状态对镇静治疗超级难治。她在第31天接受了ECT治疗，单次ECT治疗后脑电图（EEG）模式显著改善，癫痫持续状态得到缓解。我们检索了PubMed并整理了涉及ECT用于癫痫持续状态的病例报告，重点关注各种混杂因素的差异，尤其是癫痫持续状态的病因和年龄组。
我们的病例是首例报道的ECT成功治疗妊娠期SRSE的病例。虽然大多数AEDs在妊娠期对母婴有重大风险，但ECT可能是妊娠期SE的潜在一线治疗方法。
