Abstracts

Rationale: Status epilepticus (SE) is a life threatening condition. Putting patients into comatose state for refractory SE carries a high mortality rate. Electroconvulsive therapy (ECT) has been employed successfully as a treatment for refractory epilepsy and SE after exhausting conventional therapy. However, ECT is used on a limited basis for pediatric patients even in psychiatric illness. We describe a pediatric case in which ECT was used successfully to treat medically refractory nonconvulsive status epilepticus (NCSE). Methods: A 7-year old female with cerebral palsy, developmental delay, and medically refractory epilepsy developed NCSE shortly after admission for video EEG (vEEG) monitoring without medication reduction. Burst suppression was achieved with multiple concomitant intravenous anesthetics after increasing AEDs used on admission. After unsuccessful attempts to wean from drug induced coma due to return of NCSE, ECT treatment was initiated with parental consent. She received three stimulations with bilateral electrode placements daily on two successive days. Results: NCSE was terminated with the first six stimulations during the two initial sessions. After two days, NCSE returned and continued for five days. Repeat ECT with six stimulations in 2 sessions with the final stimulus producing generalized EEG seizure caused resolution of NCSE again. Three weeks after final ECT and weaning of medicine, she is more alert and moving but with moderate worsening of encephalopahty and infrequent absence seizures. Conclusions: Despite the reports of effectiveness of ECT in SE, it is used infrequently and most reports are based on adult patients. Three was only one pediatric case report with ECT being used to treat two children with refractory epilepsy, but their AEDs were either held or completely stopped before the ECT treatment. To our knowledge, our case is the first report for successful ECT treatment on pediatric NCSE with continuation of AED.