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Estado de Mal EpilĂ©tico e Potencial TerapĂȘutico da Eletroconvulsivoterapia
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Advisor(s)
Abstract(s)
Introdução: O estado de mal epilĂ©tico (EME) constitui uma emergĂȘncia neurolĂłgica
definida por crises epiléticas prolongadas ou recorrentes sem recuperação completa da
consciĂȘncia, representando risco de dano neurolĂłgico permanente. Em situaçÔes
refratårias, em que os tratamentos convencionais com fårmacos anti-crises epiléticas
(FACEs) nĂŁo sĂŁo eficazes, a eletroconvulsivoterapia (ECT) Ă© uma alternativa terapĂȘutica
emergente, apesar de seu uso ainda ser considerado off-label.
MĂ©todos: Realizou-se uma revisĂŁo de literatura com pesquisa de artigos nas bases de
dados PubMed e Scopus entre janeiro e fevereiro de 2025, abrangendo estudos primĂĄrios
publicados entre 2000 e 2025. Foram estabelecidos critérios rigorosos de inclusão e
exclusĂŁo, resultando na seleção de 11 artigos, dos quais 35 casos clĂnicos de EME tratados
com ECT foram analisados.
Resultados: A anĂĄlise dos estudos revelou uma considerĂĄvel variabilidade nos
protocolos de ECT. Destacam-se algumas tendĂȘncias comuns nos casos com resposta
positiva: uso preferencial de elĂ©trodos bitemporais, cargas elevadas de estĂmulo,
titulação progressiva da dose e suspensão controlada de anestésicos. 31 dos 35 doentes
cessaram EME após a aplicação da ECT. Contudo, a maioria manteve sequelas associadas
à longa duração e à etiologia do EME. Nenhuma sequela foi associada à ECT.
Discussão: Os resultados sugerem que a ECT pode representar uma estratégia
terapĂȘutica viĂĄvel e eficaz no EME refratĂĄrio, proporcionando uma alternativa Ă s
terapĂȘuticas convencionais. Todavia, a heterogeneidade dos protocolos utilizados e da
informação registada nos relatórios de caso destaca a necessidade de estudos
padronizados e de maior rigor metodolĂłgico para definir parĂąmetros terapĂȘuticos ideais.
ConclusĂŁo: A ECT representa uma opção terapĂȘutica promissora para o tratamento do
estado de mal epilético refratårio, com taxas elevadas de cessação das crises e perfil de
segurança aceitåvel quando aplicada em ambiente monitorizado. Apesar da
heterogeneidade dos protocolos e da escassez de evidĂȘncia robusta, os dados disponĂveis
sugerem que a ECT pode atuar como terapia de resgate eficaz e até como ponte para
outras intervençÔes. A necessidade de padronização técnica, a maior investigação
prospetiva e definição de critérios de seleção são essenciais para clarificar o seu papel no
algoritmo terapĂȘutico do EME.
Introduction: Status epilepticus is a neurological emergency defined by prolonged or recurrent epileptic seizures without full recovery of consciousness, posing a risk of permanent neurological damage. In refractory cases, where conventional treatment with anti-seizure medications fails to terminate the seizures, electroconvulsive therapy (ECT) emerges as a therapeutic alternative, although its use is still considered off-label. Methods: A literature search was conducted in the PubMed and Scopus databases between January and February 2025, including primary studies published from 2000 to 2025. Strict inclusion and exclusion criteria were applied, resulting in the selection of 11 articles, from which 35 clinical cases of status epilepticus treated with ECT were analyzed. Results: The analysis of the studies revealed considerable variability in ECT protocols. However, some common trends emerged in cases with a positive response: preferential use of bitemporal electrodes, high stimulation charges, progressive dose titration, and controlled suspension of anesthetics. ECT led to cessation of status epilepticus in 31 out of 35 patients. Nevertheless, most patients developed sequelae related to the prolonged duration and underlying etiology of the condition, with no adverse effects directly attributed to ECT. Discussion: The results suggest that ECT may represent a viable and effective therapeutic strategy for refractory status epilepticus, offering an alternative when conventional treatments fail. However, the heterogeneity of the protocols used and the variability in the information recorded in case reports highlight the need for standardized studies and greater methodological rigor to define optimal therapeutic parameters. Conclusion: ECT appears to be a promising therapeutic option for the treatment of refractory status epilepticus, showing high rates of seizure cessation and an acceptable safety profile when applied in a monitored setting. Despite the heterogeneity of protocols and limited high-quality evidence, available data suggests that ECT may serve as an effective rescue therapy and even as a bridge to other interventions. Technical standardization, prospective research, and clear selection criteria are essential to define ECTâs role in the therapeutic algorithm for status epilepticus.
Introduction: Status epilepticus is a neurological emergency defined by prolonged or recurrent epileptic seizures without full recovery of consciousness, posing a risk of permanent neurological damage. In refractory cases, where conventional treatment with anti-seizure medications fails to terminate the seizures, electroconvulsive therapy (ECT) emerges as a therapeutic alternative, although its use is still considered off-label. Methods: A literature search was conducted in the PubMed and Scopus databases between January and February 2025, including primary studies published from 2000 to 2025. Strict inclusion and exclusion criteria were applied, resulting in the selection of 11 articles, from which 35 clinical cases of status epilepticus treated with ECT were analyzed. Results: The analysis of the studies revealed considerable variability in ECT protocols. However, some common trends emerged in cases with a positive response: preferential use of bitemporal electrodes, high stimulation charges, progressive dose titration, and controlled suspension of anesthetics. ECT led to cessation of status epilepticus in 31 out of 35 patients. Nevertheless, most patients developed sequelae related to the prolonged duration and underlying etiology of the condition, with no adverse effects directly attributed to ECT. Discussion: The results suggest that ECT may represent a viable and effective therapeutic strategy for refractory status epilepticus, offering an alternative when conventional treatments fail. However, the heterogeneity of the protocols used and the variability in the information recorded in case reports highlight the need for standardized studies and greater methodological rigor to define optimal therapeutic parameters. Conclusion: ECT appears to be a promising therapeutic option for the treatment of refractory status epilepticus, showing high rates of seizure cessation and an acceptable safety profile when applied in a monitored setting. Despite the heterogeneity of protocols and limited high-quality evidence, available data suggests that ECT may serve as an effective rescue therapy and even as a bridge to other interventions. Technical standardization, prospective research, and clear selection criteria are essential to define ECTâs role in the therapeutic algorithm for status epilepticus.
Description
Keywords
Electroconvulsive
Therapy Neurophysiology Refractory Status Epilepticus Status Epilepticus