Treatment of status epilepticus with electroconvulsive therapy

Objective: To describe a case in which electroconvulsive therapy (ECT) was used successfully to treat refractory status epilepticus (SE) after all pharmacological therapies were exhausted. Methods: A 39-year-old man with no seizure history presented in SE secondary to presumed viral encephalitis. His seizures remained refractory to medical management, and he was placed in a pentobarbital-induced coma. Multiple attempts to wean pentobarbital over the next several months failed due to SE relapses. With all standard pharmacological therapies exhausted, the patient underwent a series of 3 ECT sessions per day for 3 consecutive days. Electroencephalogram improvements were noted immediately with diffusely slow activity and with a delayed response over time in the patient's neurological examination. Twelve months post-ECT, the patient is awake, alert, and being managed on antiepileptic medications as outpatient. Discussion: This case further illustrates the role of ECT in the treatment of refractory SE.