Potential mechanisms and clinical applications of mild hypothermia and electroconvulsive therapy on refractory status epilepticus

Abstract

Status epilepticus (SE) is an acute and severe neurological disorder. A small number of SE cases cannot be terminated by a sufficient therapeutic dose and duration of two to three common anticonvulsant therapies. The continuing seizures often lead to poor prognosis and a higher mortality rate. Novel non-drug treatment options to terminate SE are greatly needed. Induced hypothermia and electroconvulsive therapies are used to treat SE. There are many case studies and multiple experimental investigations of these methods in the literature. This article reviews the historical evolution, mechanisms, clinical applications and adverse reactions of SE, some of which have shown that both treatments are beneficial and relatively safe. The purpose of this paper is to provide alternative treatment methods for SE.

Keywords:

• electroconvulsive therapy
• epilepsy
• hypothermia
• seizure
• status epilepticus

Financial & competing interests disclosure

This research was supported by the National Natural Science Foundation Project 960 (81271445 and 81201003) and the Foundation for PAR-EU Scholars program. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Status epilepticus (SE) is a severe neurological disease. Some patients’ seizures are difficult or impossible to control with antiepileptic drug treatment, and refractory SE (RSE) or super RSE (SRSE) may develop. RSE and SRSE must be terminated as soon as possible because of the high mortality rate.

• Over the past 50 years, studies have found that hypothermia can weaken cortical electrical activity. A series of studies and clinical case reports support a role for hypothermia in the treatment of SE.

• The mechanism of hypothermia is related to neurotransmitters, and hypothermia has a protective effect in the brain.

• Previous cases in which hypothermia was used for SE treatment are listed, and the treatment methods are summarized.

• Hypothermia may cause side effects during and post-treatment.

• The historical evolution of electroconvulsive therapies (ECT) is traced from its psychiatric roots to its current application for anti-SE.

• The mechanism of ECT is related to neurotransmitter and NMDA receptor activation, and ECT has an anti-apoptotic effect.

• The clinical use of ECT in SE are reviewed, and the treatment schemes are summarized.

• ECT may cause mild side effects during and post-treatment.

Notes