Rescue use of electroconvulsive therapy in new-onset refractory status epilepticus during pregnancy

BMJ Case Rep. 2025 Aug 6;18(8):e266413. doi: 10.1136/bcr-2025-266413.

ABSTRACT

New-onset refractory status epilepticus (NORSE) presents a significant challenge, particularly in the absence of a clear aetiology and resistance to conventional treatments. Managing NORSE during pregnancy is even more complex due to the lack of established guidelines and concerns over the teratogenicity of available antiepileptic drugs (AEDs).A previously healthy pregnant woman with no history of seizures developed refractory NORSE, resistant to multiple AEDs and anaesthetic infusions. A provisional diagnosis of autoimmune encephalitis was considered and treated with pulse steroids and IV immunoglobulins, but her seizures persisted. Given the refractoriness of her condition, electroconvulsive therapy (ECT) was initiated, leading to gradual clinical improvement. This allowed for the tapering off of anaesthetic medications and ventilator support.The patient was eventually discharged after 42 days of hospital stay on multiple AEDs, without any residual deficits. This case underscores the potential role of ECT as a viable therapeutic option in such complex scenarios.

PMID:40774775 | DOI:10.1136/bcr-2025-266413