PMID- 28802513
OWN - NLM
STAT- MEDLINE
DCOM- 20190206
LR  - 20190215
IS  - 1545-7206 (Electronic)
IS  - 0033-3182 (Linking)
VI  - 59
IP  - 1
DP  - 2018 Jan-Feb
TI  - Nonconvulsive Status Epilepticus After Electroconvulsive Therapy: A Review of 
      Literature.
PG  - 36-46
LID - S0033-3182(17)30158-5 [pii]
LID - 10.1016/j.psym.2017.07.005 [doi]
AB  - 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.
CI  - Copyright (c) 2018 The Academy of Psychosomatic Medicine. Published by Elsevier 
      Inc. All rights reserved.
FAU - Aftab, Awais
AU  - Aftab A
AD  - Department of Psychiatry, University Hospitals Cleveland Medical Center, Case 
      Western Reserve University, Cleveland, OH. Electronic address: 
      awaisaftab@gmail.com.
FAU - VanDercar, Ashley
AU  - VanDercar A
AD  - Department of Psychiatry, University Hospitals Cleveland Medical Center, Case 
      Western Reserve University, Cleveland, OH.
FAU - Alkhachroum, Ayham
AU  - Alkhachroum A
AD  - Department of Neurology, University Hospitals Cleveland Medical Center, Case 
      Western Reserve University, Cleveland, OH.
FAU - LaGrotta, Christine
AU  - LaGrotta C
AD  - Department of Psychiatry, University Hospitals Cleveland Medical Center, Case 
      Western Reserve University, Cleveland, OH.
FAU - Gao, Keming
AU  - Gao K
AD  - Department of Psychiatry, University Hospitals Cleveland Medical Center, Case 
      Western Reserve University, Cleveland, OH.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20170715
PL  - England
TA  - Psychosomatics
JT  - Psychosomatics
JID - 0376506
RN  - 0 (Anticonvulsants)
RN  - 12794-10-4 (Benzodiazepines)
SB  - IM
MH  - Anticonvulsants/*therapeutic use
MH  - Benzodiazepines/*therapeutic use
MH  - Electroconvulsive Therapy/*adverse effects
MH  - Electroencephalography
MH  - Humans
MH  - Risk Factors
MH  - Status Epilepticus/*diagnosis/*drug therapy/etiology
OTO - NOTNLM
OT  - EEG.
OT  - Electroconvulsive therapy
OT  - Nonconvulsive status epilepticus
OT  - Reviews
EDAT- 2017/08/15 06:00
MHDA- 2019/02/07 06:00
CRDT- 2017/08/14 06:00
PHST- 2017/06/12 00:00 [received]
PHST- 2017/07/06 00:00 [revised]
PHST- 2017/07/07 00:00 [accepted]
PHST- 2017/08/15 06:00 [pubmed]
PHST- 2019/02/07 06:00 [medline]
PHST- 2017/08/14 06:00 [entrez]
AID - S0033-3182(17)30158-5 [pii]
AID - 10.1016/j.psym.2017.07.005 [doi]
PST - ppublish
SO  - Psychosomatics. 2018 Jan-Feb;59(1):36-46. doi: 10.1016/j.psym.2017.07.005. Epub 
      2017 Jul 15.