To report a series of patients treated with electroconvulsive therapy (ECT) in the treatment of super refractory status epilepticus (SRSE).

Retrospective chart review of patients treated at our institution with ECT for SRSE from 2014-2020 were included. Data regarding presentation, workup, treatment and outcomes were collected from medical records. Descriptive statistics were used.

Eight patients in SRSE were treated with ECT, including six women with a median (Interquartile range) age of 56.3 (26-76) years. Four cases were new onset refractory status epilepticus. Etiologies included infectious/inflammatory, structural, metabolic, genetic and cryptogenic. Electroconvulsive therapy was initiated at a mean of 23±11 days from seizure onset, following an average of 4.9 anti-epileptic drugs and 2.1 anesthetic drips. Alternative therapies including ketogenic diet, plasmapheresis and steroids were attempted prior to ECT in seven and four patients, respectively. Patients underwent a mean of 2.6 sessions. Status epilepticus resolved in six of eight patients, with a mean duration of 9.5±6.8 days following ECT initiation. Two patients had resolution within 48 hours of completion of ECT. There were no adverse events attributed to ECT, although one patient was discontinued due to worsening hypotension. Three patients died following withdraw of life sustaining therapies, four survived to discharge, and one remains hospitalized. Discharge mean Modified Rankin scale was 4.75 in survivors.

ECT was initiated weeks following SRSE onset after multiple therapeutic approaches had failed.  Following ECT, status epilepticus resolved in most patients, however, the impact of ECT versus other management is not clear. Treatment appears to be safe. Morbidity and mortality were high in our cohort. Further analyses quantifying seizure burden before and after treatment are planned.