Neuromodulation Strategies in Refractory Status Epilepticus
Summary
Refractory status epilepticus (RSE) denotes seizure activity unresponsive to first- and second-line anticonvulsant medications, while super-refractory status epilepticus (SRSE) persists or recurs despite 24 hours of anaesthetic coma. Conventional pharmacological protocols carry risks of systemic toxicity and neuronal injury, prompting exploration of neuromodulation as an adjunct or alternative. Neuromodulation harnesses electrical or magnetic stimulation to disrupt pathological hyperactivity within neural circuits, aiming to terminate seizures, minimise anaesthetic exposure and preserve cognitive function. Approaches under investigation encompass invasive techniques—such as vagus nerve stimulation (VNS) and deep brain stimulation (DBS)—as well as non-invasive modalities, notably transcranial direct current stimulation (tDCS) and electroconvulsive therapy (ECT). Emerging evidence suggests that tailored stimulation parameters can induce burst suppression or seizure abort in critically ill patients, with variable long-term outcomes. The global significance of these strategies lies in offering potentially life-saving alternatives where pharmacotherapy fails, informing treatment algorithms, and guiding multicentre trials to optimise timing, device placement and stimulation protocols.
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Neuromodulation Strategies in Refractory Status Epilepticus publication trend
The graph below shows the total number of articles in neuromodulation strategies in refractory status epilepticus across all publications each year (not limited to Nature Index journals).
Technical terms
Status epilepticus: A continuous seizure state or recurrent seizures without recovery, lasting longer than five minutes.
Refractory status epilepticus (RSE): Seizures unresponsive to two appropriately dosed antiepileptic drugs, including a benzodiazepine.
Super-refractory status epilepticus (SRSE): RSE persisting or recurring 24 hours after initiation of anaesthetic coma.
Neuromodulation: Application of electrical or magnetic stimuli to alter neuronal activity and network excitability.
Vagus nerve stimulation (VNS): Implanted device delivering intermittent electrical pulses to the vagus nerve to reduce seizure frequency.
Electroconvulsive therapy (ECT): Controlled induction of therapeutic seizures via transcranial electric currents under anaesthesia.
Transcranial direct current stimulation (tDCS): Non-invasive delivery of low-amplitude direct current through scalp electrodes to modulate cortical excitability.
Deep brain stimulation (DBS): Surgical implantation of electrodes in subcortical structures to deliver continuous or intermittent stimulation.
Electroencephalography (EEG): Recording of electrical brain activity via scalp electrodes to monitor seizure dynamics and therapeutic effects.
References
- A New Non-invasive Neuromodulation Technique for Super Refractory Status Epilepticus: Can We Consider tDCS for This Devastating Condition?. Neurotherapeutics (2022).
- Vagus Nerve Stimulation (VNS) in Super Refractory New Onset Refractory Status Epilepticus (NORSE). Case Reports in Neurological Medicine (2019).
- Electroconvulsive Therapy in Super Refractory Status Epilepticus: Case Series with a Defined Protocol. International Journal of Environmental Research and Public Health (2020).
- Long‐term outcomes after NORSE: Treatment with vagus nerve stimulation. Epilepsia Open (2022).
- Management of Super-Refractory Status Epilepticus with Isoflurane and Hypothermia. Frontiers in Neurology (2015).
- Neuromodulation Techniques in Children with Super-Refractory Status Epilepticus. Brain Sciences (2023).
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