Dowd Delaney K, Nunes Denise, Shah Pooja D, Pardo Andrea C
Department of Pediatrics (Neurology), University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Pediatrics (Neurology and Epilepsy), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Epilepsia. 2025 May 2. doi: 10.1111/epi.18432.
Status epilepticus (SE) is a neurologic emergency. Although evidence-based treatments exist for SE, treatment of refractory status epilepticus (RSE) and super refractory status epilepticus (SRSE) lacks evidence. Electroconvulsive therapy (ECT) is safe and efficacious when used to treat psychiatric disorders. Seizure control attributed to ECT in the setting of SRSE has been reported in case reports and case series. The objective of this scoping review was to understand the current knowledge regarding the safety and efficacy of ECT in aborting SRSE in the adult and pediatric populations.
This scoping review was designed based on guidelines from the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Databases were searched to identify relevant studies, which were independently appraised by reviewers. Peer-reviewed studies with focus on patients who were treated with ECT for SRSE were included. Patient demographic, ECT course, and clinical outcome data were collated in a prespecified proforma.
Data were extracted from 16 studies, which included a combined 40 patients. Ages were unknown for eight patients. Of the patients whose ages were known, more pediatric patients than adults were previously healthy, and seizure etiology differed between these two subgroups. SE was aborted in 80% of adult and 100% of pediatric patients. One adverse effect related to ECT was reported. Seizure recurrence, new epilepsy diagnoses, technology dependence, and death were common.
Differences between adult and pediatric patients who are treated with electroconvulsive therapy (ECT) for SRSE could reflect a combination of factors, including logistical and regulatory barriers that limit use of ECT in intensive care units (ICUs). Prospective, randomized controlled trials are needed to fully understand the risks vs benefits of ECT for SRSE compared to other treatments.
癫痫持续状态（SE）是一种神经系统急症。尽管有基于证据的SE治疗方法，但难治性癫痫持续状态（RSE）和超级难治性癫痫持续状态（SRSE）的治疗缺乏证据。电休克治疗（ECT）用于治疗精神疾病时安全有效。在病例报告和病例系列中，已有关于ECT在SRSE情况下控制癫痫发作的报道。本范围综述的目的是了解目前关于ECT在成人和儿童群体中终止SRSE的安全性和有效性的知识。
本范围综述是根据乔安娜·布里格斯研究所（JBI）的指南以及系统评价和Meta分析扩展的范围综述首选报告项目（PRISMA-ScR）清单设计的。检索数据库以识别相关研究，由评审人员独立评估。纳入聚焦于接受ECT治疗SRSE患者的同行评审研究。患者人口统计学、ECT疗程和临床结局数据按照预先指定的格式进行整理。
从16项研究中提取数据，共包括40例患者。8例患者年龄未知。在年龄已知的患者中，先前健康的儿童患者比成人患者更多，且这两个亚组的癫痫病因不同。80%的成年患者和100%的儿童患者的SE得到终止。报告了1例与ECT相关的不良反应。癫痫复发、新的癫痫诊断、技术依赖和死亡很常见。
接受电休克治疗（ECT）的成年和儿童SRSE患者之间的差异可能反映多种因素的综合作用，包括限制ECT在重症监护病房（ICU）使用的后勤和监管障碍。需要进行前瞻性、随机对照试验，以充分了解与其他治疗相比，ECT治疗SRSE的风险与益处。
