The Use of Electroconvulsive Therapy (ECT) in the New Onset Refractory Status Epilepticus (NORSE)—Case Report and Systematic Review

New-onset refractory status epilepticus (NORSE) is a severe and often fatal neurological condition characterized by continuous or recurrent seizures unresponsive to standard antiseizure therapies. Management remains highly challenging due to unclear etiologies and resistance to conventional treatment. Electroconvulsive therapy (ECT) has emerged as a potential intervention. This study systematically reviewed reported NORSE cases treated with ECT to evaluate efficacy, safety, and outcomes. A comprehensive literature search of PUBMED, EMBASE, and SCOPUS was conducted in June 2024. English-language reports describing ECT-managed NORSE cases were included, while studies focusing on psychiatric disorders or lacking specific neuromodulation details were excluded. Extracted data included demographics, clinical presentation, EEG and imaging findings, prior treatments, ECT parameters, complications, and clinical outcomes. Of 1039 records screened, 5 studies encompassing 6 cases met the inclusion criteria; combined with our local case, 7 total cases were analyzed. The mean patient age was 37.1 years, and 57% were female. Neuroimaging abnormalities were present in 71% of cases, and cerebrospinal fluid abnormalities in 40%. All patients received multiple antiseizure medications (mean 7) before ECT. The average number of ECT sessions was 9.7. Seizure remission occurred in 71% of cases, with partial improvement in 29%. Cognitive impairments were observed in 42% of patients, and overall functional outcomes varied. ECT demonstrated notable efficacy as salvage treatment for NORSE, achieving seizure remission or reduction in most patients without severe adverse effects. These findings support ECT as a potential therapeutic option in NORSE when standard interventions fail.