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Nonconvulsive Status Epilepticus After Electroconvulsive Therapy: A Review of Literature
- Source :
- Psychosomatics. 59:36-46
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Background The clinical presentation and risk factors of nonconvulsive status epilepticus (NCSE) in the context of electroconvulsive therapy (ECT) are poorly understood, and guidance regarding diagnosis and management remains scarce. In this article, we identify case reports of ECT-induced NCSE from literature, and discuss the presentation, diagnosis, and management of these cases in the context of what is known about NCSE from the neurology literature. Methods A literature search on PubMed for case reports of NCSE after ECT. Results We identified 13 cases for this review. Diagnosis in all cases was based on clinical features and electroencephalogram (EEG) findings. Clinical presentation was altered mental status or unresponsiveness, with subtle motor phenomena in some cases. All cases had nonspecific risk factors that have been associated with prolonged seizures and convulsions, such as recent discontinuation/reduction of benzodiazepines or anticonvulsants, and concurrent use of antipsychotics and antidepressants. All patients were treated with either benzodiazepines or antiepileptic agents. Outcomes in these post-ECT NCSE cases were generally favorable. Discussion Although rare, post-ECT NCSE should be kept in mind by physicians when confusion or unresponsiveness develops and continues after ECT; multilead EEG is gold standard for diagnosis. An intravenous (IV) antiepileptic drug (AED) challenge can help clarify the diagnosis. Initial treatment is recommended with IV benzodiazepines, with a repeat dose if necessary. If seizures persist, IV AEDs are warranted. NCSE refractory to this treatment should be treated with a scheduled IV or oral AED. Serial multilead EEGs should be used to monitor resolution of symptoms. Conclusion NCSE after ECT is a rare but recognizable clinical event. A high clinical suspicion and low threshold for EEG is necessary for prompt diagnosis.
- Subjects :
- Pediatrics
medicine.medical_specialty
Neurology
medicine.medical_treatment
Context (language use)
Status epilepticus
Electroencephalography
Benzodiazepines
03 medical and health sciences
Status Epilepticus
0302 clinical medicine
Electroconvulsive therapy
Arts and Humanities (miscellaneous)
Altered Mental Status
Risk Factors
Humans
Medicine
Electroconvulsive Therapy
Applied Psychology
medicine.diagnostic_test
business.industry
Gold standard
030227 psychiatry
Discontinuation
Psychiatry and Mental health
Anesthesia
Anticonvulsants
medicine.symptom
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 00333182
- Volume :
- 59
- Database :
- OpenAIRE
- Journal :
- Psychosomatics
- Accession number :
- edsair.doi.dedup.....78987d600351e9118422b6c876b11aaf