Treatment of Super-refractory Focal Status Epilepticus Using Transcranial Direct Current Stimulation: Three Cases
Abstract number :
3.183
Submission category :
3. Neurophysiology / 3E. Brain Stimulation
Year :
2022
Submission ID :
2204873
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Ryan McGinn, MD, MASc, FRCPC – Stanford University; Kurt Qing, MD, PhD – Epilepsy Fellow, Neurology, Epilepsy, Stanford University; Erica Von Stein, MD – Epilepsy Fellow, Neurology, Epilepsy, Stanford University; Teresa Wu, MD – Epilepsy Fellow, Neurology, Epilepsy, Stanford University; Adam fogarty, BA – EEG Technician, Neurology, Epilepsy, Stanford Health Care; Chitra Venkatasubramanian, MBBS, MD – Clinical Professor, Neurology, Neurocritical care, Stanford University; Prashanth Krishnamohan, MD – Clinical Assistant Professor, Neurology, Neurocritical care, Stanford University; Robert fisher, MD, PhD – Maslah Saul MD Professor and Director of the Stanford Epilepsy Center, Neurology, Epilepsy, Stanford University
Rationale: Transcranial direct current stimulation (tDCS) is a nonpharmaceutical, noninvasive, neuromodulatory technique that has shown efficacy in drug-resistant focal epilepsy in the outpatient setting1 and has possibly efficacy in treating focal status epilepticus. (SE)2 Here we report our first experiences with safety and efficacy of tDCS in treating focal, super-refractory SE in a small series of patients.
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Methods: The Stanford Institutional Review Board approved the protocol and use of proxy consent. Three patients were treated in 2022, all with uni- or bi-focal electrographic SE, despite numerous antiseizure medications, including multiple anesthetic agents. Seizures were identified by usual clinical criteria. Each focus was treated by two 30-minute sessions, with a 30-minute break, for two consecutive days. Cathodal current at 2 mA was applied over the focus by a saline patch, with the anode on the shoulder.
Results: Before tDCS treatment, nonmotor SE persisted, respectively, for at least 8 days, 4 days and 21 hours. Patient 1 had a near-continuous occipital ictal-pattern, which showed a relative reduction in spike burden for up to 7 hours after stimulation. The 2 later patients exhibited frequent discrete focal seizure patterns, which showed significant decreases in hourly seizure frequencies after only one day of treatment, comparing the day before and day after stimulation onset (1.9 vs. 1.2 seizures per hour [p = 0.02], and 5.8 vs. 0.4 seizures per hour [p < 0.001]). Electrographic seizures resolved by the second day of treatment in both patients with discrete seizures, both of whom remained out of status until the end of their respective recordings, at 3.5 days and 38 hours, respectively. Patient 2 had one seizure 1.6 days after cessation of SE, and patient 3 had two seizures 10 hours after cessation of status. The first patient had a mild skin reaction to the stimulation, but no other adverse events occurred. Ultimately, life support was withdrawn for the first and third patient for medical reasons unrelated to seizures. Patient 2 was discharged in a stable, but cognitively impaired, condition.
Neurophysiology