Quantitative evaluation of electrographic response to electroconvulsive therapy in super-refractory status epilepticus
ObjectiveElectroconvulsive therapy (ECT) has been occasionally applied as a treatment for super-refractory status epilepticus (SRSE). However, the effects of ECT on electrographic activity and related clinical outcomes are largely unknown. Here, we use quantitative approaches on electroencephalograp...
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Frontiers Media S.A.
2024-12-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2024.1493336/full |
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| author | Raphaël Christin Harrison Hines Lauren Hophing Ankit N. Khambhati Edilberto Amorim Edilberto Amorim Manu Hegde Manu Hegde Elan L. Guterman Elan L. Guterman Jonathan K. Kleen Jonathan K. Kleen |
| author_facet | Raphaël Christin Harrison Hines Lauren Hophing Ankit N. Khambhati Edilberto Amorim Edilberto Amorim Manu Hegde Manu Hegde Elan L. Guterman Elan L. Guterman Jonathan K. Kleen Jonathan K. Kleen |
| author_sort | Raphaël Christin |
| collection | DOAJ |
| description | ObjectiveElectroconvulsive therapy (ECT) has been occasionally applied as a treatment for super-refractory status epilepticus (SRSE). However, the effects of ECT on electrographic activity and related clinical outcomes are largely unknown. Here, we use quantitative approaches on electroencephalography (EEG) data to evaluate the neurophysiological influences of ECT and how they may relate to patient survival.MethodsThis was a single center study of adult patients who underwent bi-frontal ECT for treatment of SRSE between 2007 and 2021. Continuous scalp EEG data obtained before and after each ECT session was converted using a linelength transform and projected into low-dimensional space using complementary linear and non-linear dimensionality reduction techniques (principal component analysis and separately uniform manifold approximation). Differences between before versus after ECT were quantified using silhouette scores. Mixed effects models evaluated whether changes in mean scores were related to time (across sessions, and separately within sessions up to 1 h after treatment) and patient outcomes (survival).ResultsEight patients underwent ECT for SRSE, ranging from 3 to 12 sessions each. Four patients survived with chronic epilepsy and varying cognitive sequelae, and four died while hospitalized. Projecting EEG data into low-dimensional space revealed several sessions with visualizable differences in electrographic activity before versus after ECT treatment. Silhouette scores significantly increased as time elapsed up to 60 min after ECT and higher scores were related to survival, though there was no significant change in scores across successive ECT sessions.DiscussionECT is associated with changes in electrographic activity in certain patients, and such changes may be associated with survival, although our study was underpowered to detect more definitive treatment-related effects. Further quantitative neurophysiology studies, and potentially clinical trials, in larger groups of patients are warranted to study direct influences of ECT treatment given the devastating and often deadly outcomes of SRSE. |
| format | Article |
| id | doaj-art-0ff85361047749bab45f036c8912f73b |
| institution | Kabale University |
| issn | 1664-2295 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj-art-0ff85361047749bab45f036c8912f73b2024-12-18T12:57:43ZengFrontiers Media S.A.Frontiers in Neurology1664-22952024-12-011510.3389/fneur.2024.14933361493336Quantitative evaluation of electrographic response to electroconvulsive therapy in super-refractory status epilepticusRaphaël Christin0Harrison Hines1Lauren Hophing2Ankit N. Khambhati3Edilberto Amorim4Edilberto Amorim5Manu Hegde6Manu Hegde7Elan L. Guterman8Elan L. Guterman9Jonathan K. Kleen10Jonathan K. Kleen11Department of Neurology, University of California, San Francisco, San Francisco, CA, United StatesDepartment of Neurology, University of California, San Francisco, San Francisco, CA, United StatesDepartment of Neurology, University of California, San Francisco, San Francisco, CA, United StatesDepartment of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United StatesDepartment of Neurology, University of California, San Francisco, San Francisco, CA, United StatesWeill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United StatesDepartment of Neurology, University of California, San Francisco, San Francisco, CA, United StatesWeill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United StatesDepartment of Neurology, University of California, San Francisco, San Francisco, CA, United StatesWeill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United StatesDepartment of Neurology, University of California, San Francisco, San Francisco, CA, United StatesWeill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United StatesObjectiveElectroconvulsive therapy (ECT) has been occasionally applied as a treatment for super-refractory status epilepticus (SRSE). However, the effects of ECT on electrographic activity and related clinical outcomes are largely unknown. Here, we use quantitative approaches on electroencephalography (EEG) data to evaluate the neurophysiological influences of ECT and how they may relate to patient survival.MethodsThis was a single center study of adult patients who underwent bi-frontal ECT for treatment of SRSE between 2007 and 2021. Continuous scalp EEG data obtained before and after each ECT session was converted using a linelength transform and projected into low-dimensional space using complementary linear and non-linear dimensionality reduction techniques (principal component analysis and separately uniform manifold approximation). Differences between before versus after ECT were quantified using silhouette scores. Mixed effects models evaluated whether changes in mean scores were related to time (across sessions, and separately within sessions up to 1 h after treatment) and patient outcomes (survival).ResultsEight patients underwent ECT for SRSE, ranging from 3 to 12 sessions each. Four patients survived with chronic epilepsy and varying cognitive sequelae, and four died while hospitalized. Projecting EEG data into low-dimensional space revealed several sessions with visualizable differences in electrographic activity before versus after ECT treatment. Silhouette scores significantly increased as time elapsed up to 60 min after ECT and higher scores were related to survival, though there was no significant change in scores across successive ECT sessions.DiscussionECT is associated with changes in electrographic activity in certain patients, and such changes may be associated with survival, although our study was underpowered to detect more definitive treatment-related effects. Further quantitative neurophysiology studies, and potentially clinical trials, in larger groups of patients are warranted to study direct influences of ECT treatment given the devastating and often deadly outcomes of SRSE.https://www.frontiersin.org/articles/10.3389/fneur.2024.1493336/fullepilepsyneurocriticalencephalitisNORSEquantitative |
| spellingShingle | Raphaël Christin Harrison Hines Lauren Hophing Ankit N. Khambhati Edilberto Amorim Edilberto Amorim Manu Hegde Manu Hegde Elan L. Guterman Elan L. Guterman Jonathan K. Kleen Jonathan K. Kleen Quantitative evaluation of electrographic response to electroconvulsive therapy in super-refractory status epilepticus Frontiers in Neurology epilepsy neurocritical encephalitis NORSE quantitative |
| title | Quantitative evaluation of electrographic response to electroconvulsive therapy in super-refractory status epilepticus |
| title_full | Quantitative evaluation of electrographic response to electroconvulsive therapy in super-refractory status epilepticus |
| title_fullStr | Quantitative evaluation of electrographic response to electroconvulsive therapy in super-refractory status epilepticus |
| title_full_unstemmed | Quantitative evaluation of electrographic response to electroconvulsive therapy in super-refractory status epilepticus |
| title_short | Quantitative evaluation of electrographic response to electroconvulsive therapy in super-refractory status epilepticus |
| title_sort | quantitative evaluation of electrographic response to electroconvulsive therapy in super refractory status epilepticus |
| topic | epilepsy neurocritical encephalitis NORSE quantitative |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2024.1493336/full |
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