Resident Pediatric Neurology Cohen Children's Medical Center New Hyde Park, New York
Rationale: New-Onset Refractory Status Epilepticus (NORSE) describes the clinical presentation of status epilepticus which fails to respond to treatment with benzodiazepine and one additional anti-seizure medication in a patient without known epilepsy or other apparent structural, toxic or metabolic disorder.1,2 NORSE does not respond to conventional treatment and may persist for weeks or months. Currently, there is limited high-quality evidence to guide management. Several case reports describe the efficacy of Electroconvulsive therapy (ECT) in aborting refractory status epilepticus; however, its application in seizure control in young children is still uncommon. Methods: We report a case of a 3-year 8-month old previously healthy girl with focal status epilepticus arising from right temporal region with abundant interictal right frontotemporal spikes unresponsive to benzodiazepines, multiple anti-seizure medications, anesthetic infusions, immunotherapy, ketamine and ketogenic diet. Serial Magnetic Resonance Imaging (MRI) scans were negative for any structural pathology. Results: ECT was eventually performed which provided a window of seizure freedom and clinical stability to perform ancillary testing such as Positron Emission Tomography (PET) scan which enabled localization and subsequent resection of seizure focus with pathologic confirmation of focal cortical dysplasia. Our report describes in detail the ECT protocol employed and anti-seizure regimen modification done to achieve optimum therapeutic response. Conclusions: To our best knowledge this is the youngest patient where ECT was employed for seizure control. Considerable stigma surrounds the use of ECT in psychiatric and neurologic disorders. We have commented extensively on its safety profile and commonly experienced adverse effects in children. Although further research is needed, ECT appears to be a safe and effective tool with potential use in treatment of refractory status epilepticus in children.
References  Gofton TE, Gaspard N, Hocker SE, Loddenkemper T, Hirsch LJ. New onset refractory status epilepticus research. Neurology 2019;92:802–10. https://doi.org/10.1212/WNL.0000000000007322.  Schneegans H, Stetefeld H, Dohmen C, Onur OA, Lehnhardt F-G. Successful Treatment of Super-Refractory Status Epilepticus with High-Intensity Electroconvulsive Therapy – A Case Report and Review of the Current Literature. J Epilepsy Res 2018;9:76–82. https://doi.org/10.14581/jer.19008. Funding: Please list any funding that was received in support of this abstract.: No funding