Pinchuk Michael, Hebbrecht Kaat, Sienaert Pascal, Boon Elizabet, Bouckaert Filip
University Psychiatric Centre KU Leuven, Leuven, Belgium.
KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, Belgium.
Front Psychiatry. 2025 May 29;16:1576374. doi: 10.3389/fpsyt.2025.1576374. eCollection 2025.
Electroconvulsive therapy (ECT) is an effective treatment for severe depression, mania, psychosis and catatonia. While seizures are considered essential for the therapeutic effect of ECT, it concurrently has an anticonvulsant effect which plays a role in its mechanism of action. This property has also prompted the use of ECT in managing status epilepticus (SE).
We report two distinct cases of prolonged seizures during ECT that persisted for more than 5 min despite administration of propofol and lorazepam, ultimately meeting criteria for status epilepticus (SE). The first case involved an 80-year old woman with severe psychotic depression starting ECT, while the second case involved a 30-year old man receiving maintenance ECT for difficult-to-treat schizophrenic psychosis. In both cases, SE was promptly terminated by restimulation, defined as an additional stimulus delivered within the same ECT session. After epilepsy and intracranial pathology were ruled out, ECT was safely resumed in both patients after switching from etomidate to propofol induction.
Status epilepticus after ECT can be resolved by restimulation when standard interventions are unsuccessful, thereby avoiding potential neurological complications. We provide an overview of the mechanism and current clinical evidence supporting this strategy, and propose an amended clinical practice protocol for SE after ECT.
电休克治疗（ECT）是治疗重度抑郁、躁狂、精神病和紧张症的有效方法。虽然癫痫发作被认为是ECT治疗效果的关键，但它同时具有抗惊厥作用，这在其作用机制中发挥着作用。这一特性也促使ECT被用于治疗癫痫持续状态（SE）。
我们报告了两例在ECT期间出现长时间癫痫发作的不同病例，尽管使用了丙泊酚和劳拉西泮，癫痫发作仍持续超过5分钟，最终符合癫痫持续状态（SE）的标准。第一例是一名80岁患有重度精神病性抑郁症的女性开始接受ECT治疗，第二例是一名30岁男性因难治性精神分裂症性精神病接受维持性ECT治疗。在这两例中，通过再次刺激迅速终止了SE，再次刺激定义为在同一ECT疗程内给予额外刺激。在排除癫痫和颅内病变后，两名患者从依托咪酯改为丙泊酚诱导后，均安全地恢复了ECT治疗。
当标准干预措施失败时，ECT后癫痫持续状态可通过再次刺激得到解决，从而避免潜在的神经并发症。我们概述了支持该策略的机制和当前临床证据，并提出了ECT后SE的修订临床实践方案。
