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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

SO269

Use of electroconvulsive therapy (ECT) in new-onset refractory status epilepticus (NORSE): a case report and systematic review

THE USE OF ELECTROCONVULSIVE THERAPY (ECT) IN THE NEW ONSET REFRACTORY STATUS EPILEPTICUS (NORSE)—CASE REPORT AND SYSTEMATIC REVIEW

All seven NORSE cases treated with ECT responded, with seizure remission achieved in 71% and no serious adverse effects reported.

The aim was to evaluate the efficacy, safety, and outcomes of electroconvulsive therapy (ECT) in new-onset refractory status epilepticus (NORSE), a condition unresponsive to standard antiseizure treatments and associated with high morbidity and mortality. A PRISMA-compliant search of PubMed, EMBASE, and SCOPUS was conducted in June 2024; of the 1,039 records screened, 5 studies comprising 6 cases met the eligibility criteria, and a total of 7 cases were analyzed, including the institution's own case. The mean age was 37.1 years, and 57% were female; the mean interval from admission to the first ECT session was 37 days, and the mean number of ECT sessions was 9.7. Seizure remission was observed in 71% of cases and partial improvement in 29%; all seven cases responded (5 with remission and 2 with partial improvement), and no serious adverse effects were reported. The abstract also reported neuroimaging abnormalities in 71% of cases, cerebrospinal fluid abnormalities in 40%, use of a mean of 7 antiseizure medications before ECT, and cognitive impairment in 42%. The institution's case was a 30-year-old man with generalized tonic-clonic seizures refractory to five antiseizure medications, who tested positive for anti-GAD65 antibodies after discharge. Following the failure of midazolam, ketamine, pentobarbital, corticosteroids, plasmapheresis, IVIG, rituximab, and a ketogenic diet, he received 12 sessions of bitemporal ECT over 12 days using the Maryland protocol; remission was achieved at 2 months, and he was discharged to rehabilitation. The authors concluded that ECT may be an option as a rescue treatment for NORSE when standard interventions are insufficient, and that the apparent association between fewer sessions and better outcomes supports early ECT. However, they noted that the evidence was small-scale and retrospective, and that prospective studies were needed.

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