Restimulation could stop status epilepticus after electroconvulsive therapy: 2 case reports
BackgroundElectroconvulsive 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 prope...
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Frontiers Media S.A.
2025-05-01
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| author | Michael Pinchuk Kaat Hebbrecht Kaat Hebbrecht Pascal Sienaert Pascal Sienaert Elizabet Boon Filip Bouckaert Filip Bouckaert |
| author_facet | Michael Pinchuk Kaat Hebbrecht Kaat Hebbrecht Pascal Sienaert Pascal Sienaert Elizabet Boon Filip Bouckaert Filip Bouckaert |
| author_sort | Michael Pinchuk |
| collection | DOAJ |
| description | BackgroundElectroconvulsive 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).Case PresentationWe 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.ConclusionStatus 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. |
| format | Article |
| id | doaj-art-f485c0b5ba714a0f947590b0a58075b7 |
| institution | OA Journals |
| issn | 1664-0640 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Psychiatry |
| spelling | doaj-art-f485c0b5ba714a0f947590b0a58075b72025-08-20T02:16:44ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402025-05-011610.3389/fpsyt.2025.15763741576374Restimulation could stop status epilepticus after electroconvulsive therapy: 2 case reportsMichael Pinchuk0Kaat Hebbrecht1Kaat Hebbrecht2Pascal Sienaert3Pascal Sienaert4Elizabet Boon5Filip Bouckaert6Filip Bouckaert7University Psychiatric Centre KU Leuven, Leuven, BelgiumUniversity Psychiatric Centre KU Leuven, Leuven, BelgiumKU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, BelgiumUniversity Psychiatric Centre KU Leuven, Leuven, BelgiumKU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, BelgiumUniversity Psychiatric Centre KU Leuven, Leuven, BelgiumKU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven, Kortenberg, BelgiumKU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, B-3000, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Centre KU Leuven, Leuven, BelgiumBackgroundElectroconvulsive 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).Case PresentationWe 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.ConclusionStatus 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.https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1576374/fullelectroconvulsive therapystatus epilepticusprolonged seizuremechanismcomplicationanticonvulsant hypothesis |
| spellingShingle | Michael Pinchuk Kaat Hebbrecht Kaat Hebbrecht Pascal Sienaert Pascal Sienaert Elizabet Boon Filip Bouckaert Filip Bouckaert Restimulation could stop status epilepticus after electroconvulsive therapy: 2 case reports Frontiers in Psychiatry electroconvulsive therapy status epilepticus prolonged seizure mechanism complication anticonvulsant hypothesis |
| title | Restimulation could stop status epilepticus after electroconvulsive therapy: 2 case reports |
| title_full | Restimulation could stop status epilepticus after electroconvulsive therapy: 2 case reports |
| title_fullStr | Restimulation could stop status epilepticus after electroconvulsive therapy: 2 case reports |
| title_full_unstemmed | Restimulation could stop status epilepticus after electroconvulsive therapy: 2 case reports |
| title_short | Restimulation could stop status epilepticus after electroconvulsive therapy: 2 case reports |
| title_sort | restimulation could stop status epilepticus after electroconvulsive therapy 2 case reports |
| topic | electroconvulsive therapy status epilepticus prolonged seizure mechanism complication anticonvulsant hypothesis |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1576374/full |
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