Christin Raphaël, Hines Harrison, Hophing Lauren, Khambhati Ankit N, Amorim Edilberto, Hegde Manu, Guterman Elan L, Kleen Jonathan K
Department of Neurology, University of California, San Francisco, San Francisco, CA, United States.
Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.
Front Neurol. 2024 Dec 16;15:1493336. doi: 10.3389/fneur.2024.1493336. eCollection 2024.
Electroconvulsive therapy (ECT) has been occasionally applied as a treatment for super-refractory status epilepticus (SRSE). However, the effects of ECT on electrographic activity and related clinical outcomes are largely unknown. Here, we use quantitative approaches on electroencephalography (EEG) data to evaluate the neurophysiological influences of ECT and how they may relate to patient survival.
This was a single center study of adult patients who underwent bi-frontal ECT for treatment of SRSE between 2007 and 2021. Continuous scalp EEG data obtained before and after each ECT session was converted using a linelength transform and projected into low-dimensional space using complementary linear and non-linear dimensionality reduction techniques (principal component analysis and separately uniform manifold approximation). Differences between before versus after ECT were quantified using silhouette scores. Mixed effects models evaluated whether changes in mean scores were related to time (across sessions, and separately within sessions up to 1 h after treatment) and patient outcomes (survival).
Eight patients underwent ECT for SRSE, ranging from 3 to 12 sessions each. Four patients survived with chronic epilepsy and varying cognitive sequelae, and four died while hospitalized. Projecting EEG data into low-dimensional space revealed several sessions with visualizable differences in electrographic activity before versus after ECT treatment. Silhouette scores significantly increased as time elapsed up to 60 min after ECT and higher scores were related to survival, though there was no significant change in scores across successive ECT sessions.
ECT is associated with changes in electrographic activity in certain patients, and such changes may be associated with survival, although our study was underpowered to detect more definitive treatment-related effects. Further quantitative neurophysiology studies, and potentially clinical trials, in larger groups of patients are warranted to study direct influences of ECT treatment given the devastating and often deadly outcomes of SRSE.
电休克治疗（ECT）偶尔被用作超难治性癫痫持续状态（SRSE）的一种治疗方法。然而，ECT对脑电图活动及相关临床结局的影响在很大程度上尚不清楚。在此，我们采用定量方法分析脑电图（EEG）数据，以评估ECT的神经生理影响以及它们与患者生存的关系。
这是一项针对2007年至2021年间接受双额叶ECT治疗SRSE的成年患者的单中心研究。每次ECT治疗前后获得的连续头皮EEG数据通过线长变换进行转换，并使用互补的线性和非线性降维技术（主成分分析和单独的均匀流形逼近）投影到低维空间。使用轮廓系数对ECT前后的差异进行量化。混合效应模型评估平均分数的变化是否与时间（跨疗程，以及分别在治疗后1小时内的疗程内）和患者结局（生存）相关。
8例患者接受了ECT治疗SRSE，每人接受3至12个疗程。4例患者存活，伴有慢性癫痫和不同程度的认知后遗症，4例患者在住院期间死亡。将EEG数据投影到低维空间显示，ECT治疗前后的脑电图活动在几个疗程中存在明显的可视化差异。轮廓系数在ECT后60分钟内随时间显著增加，较高的分数与生存相关，尽管在连续的ECT疗程中分数没有显著变化。
ECT与某些患者脑电图活动的变化有关，这种变化可能与生存有关，尽管我们的研究样本量不足以检测到更明确的与治疗相关的效应。鉴于SRSE的毁灭性且往往致命的结局，有必要在更大规模的患者群体中进行进一步的定量神经生理学研究以及潜在的临床试验，以研究ECT治疗的直接影响。
