Journal
JOURNAL OF CLINICAL NEUROPHYSIOLOGY
Volume 38, Issue 6, Pages 494-502Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/WNP.0000000000000710
Keywords
Super-refractory status epilepticus; Neuromodulation; Transcranial magnetic stimulation; Electroconvulsive therapy; Deep brain stimulation; Vagalnerve stimulation
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Status epilepticus is a severe condition that requires immediate pharmacological treatment, with a subset progressing to refractory status epilepticus and super-refractory status epilepticus, potentially causing severe brain damage. Neuromodulation techniques have shown promising results in controlling super-refractory status epilepticus, but further research is needed to confirm efficacy and explore early intervention options.
Status epilepticus (SE) is a severe condition that needs immediate pharmacological treatment to tackle brain damage and related side effects. In approximately 20% of cases, the standard treatment for SE does not control seizures, and the condition evolves to refractory SE. If refractory status epilepticus lasts more than 24 hours despite the use of anesthetic treatment, the condition is redefined as super-refractory SE (srSE). sRSE is a destructive condition, potentially to cause severe brain damage. In this review, we discuss the clinical neuromodulation techniques for controlling srSE when conventional treatments have failed: electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation, and deep brain stimulation. Data show that neuromodulation therapies can abort srSE in >80% of patients. However, no randomized, prospective, and controlled trials have been completed, and data are provided only by retrospective small case series and case reports with obvious inclination to publication bias. There is a need for further investigation into the use of neuromodulation techniques as an early treatment of srSE and to address whether an earlier intervention can prevent long-term complications.
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