Electroconvulsive Therapy for Super Refractory Status Epilepticus: A Scoping Review Protocol

Abstract (English)

Introduction 

Status epilepticus (SE), a condition characterized by abnormally prolonged seizures, is associated with significant morbidity and mortality. It is a neurologic emergency that needs to be promptly recognized and treated. Refractory status epilepticus (RSE) is defined as "status epilepticus persisting despite administration of at least two appropriately selected and dosed parenteral medications including a benzodiazepine." Super refractory status epilepticus (SRSE) is defined as "status epilepticus persisting at least 24 hours after onset of anesthesia, either without interruption despite appropriate treatment with anesthesia, recurring while on appropriate anesthetic treatment, or recurring after withdrawal of anesthesia and requiring anesthetic reintroduction." 

Electroconvulsive therapy (ECT) was initially proposed in psychiatry in the 1930s and is still in widespread use to treat refractory psychiatric disorders. ECT has medically documented safety and efficacy in this setting. Seizure reduction or control attributed to ECT in the setting of SRSE has been reported in several case reports and small case series. The mechanism by which ECT aborts SE is poorly understood. Better understanding of the impact of ECT for patients who develop SRSE on seizure burden and outcomes is still needed. 

Methods and Analysis

This scoping review protocol is based on guidelines from the Joanna Briggs Institute (JBI) and follows guidelines from the Preferred Reporting Items Checklist for Systematic Reviews and Meta-analyses (PRISMA) extension for Scoping Reviews checklist. Electronic databases (Medline [Ovid], The Cochrane Library [Wiley], Embase [Elsevier], Web of Science, and CINAHL [EBSCO]), will be searched to identify relevant papers, which will be independently appraised by two independent reviewers. Data relevant to patient population, clinical course, and outcomes will be collated in a prespecified proforma. 

Ethics and Dissemination 

Results will be disseminated through a peer-reviewed academic journal. The review itself will deal exclusively with secondary data and thus will not require ethical approval.