CASE REPORT article
Front. Psychiatry
Sec. Neurostimulation
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1576374
This article is part of the Research TopicElectroconvulsive therapy: from mechanisms to clinical practiceView all 4 articles
Restimulation could stop status epilepticus after electroconvulsive therapy: 2 case reports
Provisionally accepted
- 1University Psychiatric Center KU Leuven, Leuven, Belgium
- 2Academic Center for ECT and Neuromodulation, University Psychiatric Center KU Leuven, Leuven, Belgium
- 3Leuven Brain Institute, KU Leuven, Leuven, Belgium
- 4Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Brussels, Belgium
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Background: Electroconvulsive therapy (ECT) is an effective treatment for severe depression, mania, psychosis and catatonia. While seizures are considered essential for the therapeutic effect of ECT, it concurrently has an anticonvulsant effect which plays a role in its mechanism of action. This property has also prompted the use of ECT in managing status epilepticus (SE).Case Presentation: We report two distinct cases of prolonged seizures during ECT that persisted for more than 5 min despite administration of propofol and lorazepam, ultimately meeting criteria for status epilepticus (SE). The first case involved an 80-year old woman with severe psychotic depression starting ECT, while the second case involved a 30-year old man receiving maintenance ECT for difficult-to-treat schizophrenic psychosis. In both cases, SE was promptly terminated by restimulation, defined as an additional stimulus delivered within the same ECT session. After epilepsy and intracranial pathology were ruled out, ECT was safely resumed in both patients after switching from etomidate to propofol induction. Conclusion: Status epilepticus after ECT can be resolved by restimulation when standard interventions are unsuccessful, thereby avoiding potential neurological complications. We provide an overview of the mechanism and current clinical evidence supporting this strategy, and propose an amended clinical practice protocol for SE after ECT.
Keywords: Electroconvulsive Therapy, Status Epilepticus, prolonged seizure, Mechanism, complication, anticonvulsant hypothesis, Restimulation
Received: 13 Feb 2025; Accepted: 07 May 2025.
Copyright: © 2025 Pinchuk, Hebbrecht, Sienaert, Boon and Bouckaert. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Michael Pinchuk, University Psychiatric Center KU Leuven, Leuven, Belgium
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