Adjunctive use of electroconvulsive therapy in patients with Lennox-Gastaut syndrome and drug-resistant epilepsy: A pilot study

Background: Lennox-Gastaut syndrome (LGS) is an epileptic encephalopathy, characterized by drug-resistant multiple seizure types. The aim of this study was to determine if the adjunctive use of electroconvulsive therapy (ECT) in patients with LGS and drug-resistant epilepsy is efficacious in decreasing their seizure frequency and also to investigate its safety and tolerability.   Methods: This was an open-label pilot study with convenience sampling from one center. Bitemporal electrode placement was selected. ECT was administered three times per week for four weeks (considered as the induction phase), and then once a week for two months (considered as the maintenance phase). Follow-up visits were scheduled at 2, 3, 4, and 6 months to determine the seizure types and counts and also to determine the safety and tolerability of adjunctive use of ECT in these patients. All patients and / or their caregivers consented in writing to their participation.   Results: Seven patients were studied. Just one patient experienced more than 50% reduction in seizure frequency. One patient experienced more than 50% seizure increase with ECT. In three patients, there was an increase in aggressive behavior after receiving ECT. Two patients experienced mild and transient ataxia with ECT. One patient experienced mutism with ECT, which was transient and resolved with the termination of the procedure.   Conclusion: In this small study, adjunctive use of an intensive ECT program in patients with LGS was not efficacious in decreasing their seizure frequency. However, the safety profile was acceptable, and patients tolerated the adjunctive use of ECT very well. This finding can pave the road for future investigations.