Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1016/j.ijep.2017.01.002
Treatment of refractory status epilepticus with electroconvulsive therapy: Need for future clinical studies
Publication History
Received: 01 August 2016
Accepted: 11 January 2017
Publication Date:
06 May 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00037682/201701/lookinside/thumbnails/10-1016-j-ijep-2017-01-002-1.jpg)
Abstract
Status epilepticus (SE) is a serious medical emergency. Refractory-SE non-responsive to anesthetic medication is a life threatening condition with very high mortality rate. Proper management of those cases is a big medical challenge. Over the last two decades there are anecdotal reports of successful management of such cases with electroconvulsive therapy (ECT) in 12 patients of different age group with variable pattern of seizures and different etiology. However, there is no systematic research about it. ECT is a well-known safe, easy- to-administer, low-cost therapeutic modality in the field of neuro-psychiatry. Thus its potential to treat refractory-SE which essentially lacks effective management should be evaluated in future research. The objectives of this article are to do a thorough literature review on use of ECT in refractory-SE; mechanism of action of ECT in refractory-SE; and finally formulate a working protocol for future study of using ECT in patients of refractory-SE.
-
References
- 1 Caplan G. Treatment of epilepsy by electrically induced convulsion. BMJ 1 1945; 511-513
- 2 Caplan G. Electrical convulsive therapy in treatment of epilepsy. J Mental Sci 92 1946; 784-793
- 3 Kalinowsky LB, Kennedy F. Observation in electroshock therapy applied to problems in epilepsy. J Nerv Ment Dis 98 1943; 56-67
- 4 Lambrecq V, Villega F, Marchal C. et al. Refractory status epilepticus: electroconvulsive therapy as a possible therapeutic strategy. Seizure 21 2012; 661-664
- 5 American Psychiatric Association. The Practice of ECT: Recommendations for Treatment, Training and Privileging. 2001. American Psychiatric Association; Washington, DC:
- 6 Chen JWY, Wasterlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol 5 2006; 246-256
- 7 Sackeim HA. The anticonvulsant hypothesis of the mechanism of action of ECT: current status. J ECT 15 (01) 1999; 5-26
- 8 Mazarati AM, Baldwin RA, Sankar R, Wasterlain CG. Time dependent decrease in the effectiveness of antiepileptic drugs during the course of self sustaining status epilepticus. Brain Res 814 1998; 179-185
- 9 Vezzani A, Sperk G, Colmers WF. Neuropeptide Y: emerging evidence for a functional role in seizure modulation. Trends Neurosci 22 1999; 25-30
- 10 Liu H, Mazarati AM, Katsumori H, Sankar R, Wasterlain CG. Substance P is expressed in hippocampal principal neurons during status epilepticus and plays a critical role in the maintenance of status epilepticus. Proc Natl Acad Sci U S A 96 1999; 5286-5291
- 11 Morimoto K, Fahnestock M, Racine RJ. Kindling and status epilepticus models of epilepsy: rewiring the brain. Prog Neurobiol 73 (01) 2004; 1-60
- 12 Wasterlain CG. Inhibition of cerebral protein synthesis by epileptic seizures even without motor manifestations. Neurology 24 1974; 175-180
- 13 Jordan KG, Hirsch LJ. In nonconvulsive status epilepticus (NCSE), treat to burst-suppression: pro and con. Epilepsia 47 (01) 2006; 41-45
- 14 Lloyd KG, Thuret F, Pilc A. Upregulation of GABAb receptor binding sites in rat frontal cortex: a common action of respected administration of different classes of antidepressants and electroshock. J Pharmacol Exp Ther 235 1985; 191-199
- 15 Green A, Null D, Cown P. Increased seizure threshold following convulsion. Sandler M. Psychopharmacology of Anticonvulsants. 1982. Oxford University Press; Oxford: 16-26
- 16 Wahlestedt C, Blendy JA, Kellar KJ. Electroconvulsive shocks increase the concentration of neocortical and hippocampal neuropeptide Y like immunoreactivity in the rat. Brain Res 507 1990; 65-68
- 17 Kragh J, Tonder N, Finsen BR, Zimmer B, Bolwig TG. Repeated electroconvulsive shocks cause transient changes in rat hippocampal somatostatin and neuropeptideY immunoreactivity and mRNA in situ hybridizationsignals. Exp Brain Res 98 1994; 305-313
- 18 Mathe AA, Rudorder MV, Stenfors C. Effects of electroconvulsive treatment on somatostin, neuropeptide Y, endothelin and neurokinin A concentrations in cerebrospinal fluid of depressed patients. Depression 3 1996; 250-256
- 19 Weiner RD. Electroencephalographic correlates of ECT. Psychopharmacol Bul 18 1982; 78-81
- 20 Weiner RD. The persistence of electroconvulsive therapy-induced changes in the electroencephalogram. J Nerv Ment Dis 168 1980; 224-228
- 21 Suppes T, Webb A, Carmody T. et al. Is postictal electrical silence a predictor of response to electroconvulsive therapy. J Affect Disord 41 1996; 55-58
- 22 Krystal AD, Coffey CE, Weiner RD. et al. EEG correlates of the response to ECT. Biol Psychiatry 41 1997; 56-58
- 23 Handforth A. Postseizure inhibition of kindled seizures by electroconvulsive shock. Exp Neurology 78 1982; 483-491
- 24 Post RM, Putnam F, Contel NR, Weiss SR. Electroconvulsive seizures inhibit amygdala kindling: implications for mechanisms of action in affective illness. Epilepsia 25 1984; 234-239
- 25 Vaidya VA, Siuciak JA, Du F. Hippocampal mossy fiber sprouting induced by chronic electroconvulsive seizures. Neuroscience 89 1999; 157-166
- 26 Scott BW, Wojtowicz JM, Burnham WM. Neuronogenesis in the dentate gyrus of the rat following electroconvulsive shock seizures. Exp Neurol 165 2000; 231-236
- 27 Kokaia Z, Gido G, Ringstedt T, Bengzon J. Rapid increase of BDNF mRNA levels in cortical neurons following spreading depression: regulation by glutamatergic mechanisms independent of seizure activity. Mol Brain Res 19 1993; 277-286
- 28 Krystal AD, Weiner RD. EEG correlates of the response to ECT: a possible antidepressant role of brain-derived neurotrophic factor. J ECT 15 1999; 27-38
- 29 Delorenzo RJ, Hauser WA, Towne AR. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology 46 1996; 1029-1035
- 30 Aicardi J, Chevrie JJ. Convulsive status epilepticus in infants and children: a study of 239 cases. Epilepsia 11 1970; 187-197
- 31 Jordan KG, Hirsch LJ. In nonconvulsive status epilepticus (NCSE), treat to burst-Suppression: pro and con. Epilepsia 47 (01) 2006; 41-45
- 32 Abrams R, Volavka J, Fink M. EEG seizure patterns during multiple unilateral and bilateral ECT. Comp Psychiatry 14 1973; 25-28
- 33 Weiner RD, Rogers HJ, Davidson JR, Squire LR. Effects of stimulus parameters on cognitive side effects. Ann N Y Acad Sci 462 1986; 315-325
- 34 Gabor G, Judit T, Zsolt I. Comparison of propofol and etomidate regarding impact on seizure threshold during electroconvulsive therapy in patients with schizophrenia. Neuropsychopharmacol Hung 9 2007; 125-130
- 35 Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet 2 1974; 81-84