Owing to its potent anticonvulsant actions, electroconvulsive therapy (ECT) has been proposed as an intervention for treatment-resistant seizure disorders.
We review the literature on the use of ECT in treatment-resistant epilepsy and status epilepticus (SE) and present a case of a patient who was in nonconvulsive SE for 26 days and then treated with ECT after all standard pharmacological strategies were exhausted. Because of skull defects, a novel electrode placement was used.
Owing to massively elevated seizure threshold attributable to concomitant anticonvulsant medications, extraordinarily high electrical dosage was needed for ECT to elicit generalized seizures. Status was terminated after three successful ECT-induced seizures. However, the long-term functional outcome of the patient was poor.
The role of ECT in the treatment algorithm for SE is discussed.
*Department of Biological Psychiatry, New York State Psychiatric Institute, New York; and Departments of †Psychiatry, ‡Neurology, §Anesthesiology, and ∥Radiology, College of Physicians and Surgeons of Columbia University, New York, New York, U.S.A.
Received August 23, 2000; accepted March 8, 2001.
Address correspondence and reprint requests to Dr. S. H. Lisanby, Department of Biological Psychiatry, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 126, New York, NY 10032-2695, U.S.A. E-mail: SHL24@columbia.edu