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Is Ketamine the New Go-To Drug for Status Epilepticus?

November 11, 2022

Written by Aaron Lacy

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In children with refractory status epilepticus, around 3/4 of patients who were started on a ketamine infusion had seizure termination or improvement.

Why does this matter?
Status epilepticus is a true emergency that can lead to permanent brain damage or death if not terminated. In patients who have been started on multiple medications for status epilepticus but are still seizing, where do you turn next?

We give ketamine for pretty much everything… why not seizures too?
Neuroinflammation is thought to contribute to status epilepticus that becomes refractory, and it is hypothesized that the cytokine modulating effects of ketamine could reduce this neuroinflammation. This retrospective, single-center study looked at 69 children admitted to the ICU for refractory status epilepticus who received ketamine for seizure treatment.

All patients in this study had received antiepileptic medications prior to ketamine infusion, with a median of 3 antiepileptic drugs. Based on continuous EEG monitoring, patients who received ketamine infusions for refractory status epilepticus had seizure termination in 32 cases (46%), seizure reduction in 19 cases (28%), and no change in 18 cases (26%). 2 patients developed hypertension, and 1 patient developed delirium.

It really seems like we are throwing ketamine at everything – and it’s working. Ketamine was more efficacious at stopping epileptic activity when used as the first anesthetic (dose: 1mg/kg/hr) opposed to midazolam. When throwing the kitchen sink at your status epilepticus patient, consider going to ketamine as your sedative. This study is retrospective and had a small sample size but is thought provoking and opens the door for further research. As an ER doc I’ll be sure to keep my eyes open for another indication to give ketamine…

Ketamine for Management of Neonatal and Pediatric Refractory Status Epilepticus. Neurology. 2022 Sep 20. Doi:10.1212/WNL.0000000000200889

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