Departments of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA; Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.
Departments of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
Epilepsy Behav. 2023 Jul;144:109286. doi: 10.1016/j.yebeh.2023.109286. Epub 2023 Jun 3.
Clinicians have treated super refractory status epilepticus (SRSE) with electroconvulsive therapy (ECT); however, data supporting the practice are scant and lack rigorous evaluation of continuous electroencephalogram (cEEG) changes related to therapy. This study aims to describe a series of patients with SRSE treated at our institution with ECT and characterize cEEG changes using a blinded review process.
We performed a single-center retrospective study of consecutive patients admitted for SRSE and treated with ECT from January 2014 to December 2022. Our primary outcome was the resolution of SRSE. Secondary outcomes included changes in ictal-interictal EEG patterns, anesthetic burden, treatment-associated adverse events, and changes in clinical examination. cEEG was reviewed pre- and post-ECT by blinded epileptologists.
Ten patients underwent treatment with ECT across 11 admissions (8 female, median age 57 years). At the time of ECT initiation, nine patients had ongoing SRSE while two had highly ictal patterns and persistent encephalopathy following anesthetic wean, consistent with late-stage SRSE. Super-refractory status epilepticus resolution occurred with a median time to cessation of 4 days (interquartile range [IQR]: 3-9 days) following ECT initiation. Background continuity improved in five patients and periodic discharge frequency decreased in six. There was a decrease in anesthetic use following the completion of ECT and an improvement in neurological exams. There were no associated adverse events.
In our cohort, ECT was associated with improvement of ictal-interictal patterns on EEG, and resolution of SRSE, and was not associated with serious adverse events. Further controlled studies are needed.
临床医生已经使用电惊厥疗法（ECT）治疗超难治性癫痫持续状态（SRSE）；然而，支持这一实践的数据很少，并且缺乏对与治疗相关的连续脑电图（cEEG）变化的严格评估。本研究旨在描述我们机构中一系列接受 ECT 治疗的 SRSE 患者，并使用盲法审查过程描述 cEEG 变化。
我们对 2014 年 1 月至 2022 年 12 月连续因 SRSE 入院并接受 ECT 治疗的患者进行了单中心回顾性研究。我们的主要结局是 SRSE 的缓解。次要结局包括癫痫发作-癫痫发作脑电图模式的变化、麻醉负担、治疗相关不良事件以及临床检查的变化。cEEG 在 ECT 前后由盲法癫痫学家进行审查。
11 次入院中有 10 名患者接受了 ECT 治疗（8 名女性，中位年龄 57 岁）。在开始 ECT 时，9 名患者持续存在 SRSE，而 2 名患者在麻醉减药后具有高度癫痫发作模式和持续性脑病，符合晚期 SRSE。ECT 启动后，中位时间为 4 天（四分位距[IQR]：3-9 天）停止 SRSE。五名患者的背景连续性得到改善，六名患者的周期性放电频率降低。ECT 完成后麻醉使用减少，神经检查改善。没有相关的不良事件。
在我们的队列中，ECT 与 EEG 上癫痫发作-癫痫发作模式的改善以及 SRSE 的缓解相关，并且与严重不良事件无关。需要进一步的对照研究。
