Intravenous ketamine in status epilepticus

Epilepsia
J Höfler, E Trinka

Abstract

Status epilepticus (SE) is among the most common neurological emergencies. In refractory SE, due to subcellular maladaptive changes, γ-aminobutyric acidergic drugs are no longer effective, and there is an increase in synaptic N-methyl-d-aspartate (NMDA) receptors. Ketamine (KET) is a noncompetitive N-methyl-d-aspartate receptor antagonist that could be of value in the treatment of refractory SE. The aim was to analyze all published studies on KET in the treatment of SE. A systematic search (PubMed) of the literature identified 25 studies (from December 1996 to March 2017); with the exception of two prospective studies, all studies were retrospective in nature and published as a full paper. To date, PubMed lists a total number of 244 episodes of SE treated with KET (13 case reports and five case series in adults; four case reports and three case series in children); the overall success rate was 74% (153/207) in adults and 73% (27/37) in children. Adverse events were rare. Current evidence on the use of KET in acute seizures and SE is mostly restricted to retrospective case reports and case series, except for two prospective case series without control (class IV). Further prospective studies to inform clinicians are necessary.

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Citations

Jan 8, 2019·Acta Neurologica Scandinavica·Adam StrzelczykFelix Rosenow
Jun 18, 2019·Epilepsia·Leah CrollOrrin Devinsky
Feb 27, 2020·Journal of Anesthesia·Yoshikazu YamaguchiJoseph D Tobias
Feb 19, 2019·Current Treatment Options in Neurology·Stephanie AhrensLaurel A Slaughter
Mar 12, 2019·Current Opinion in Critical Care·Baxter Allen, Paul M Vespa
Sep 6, 2020·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Suchitra Joshi, Howard P Goodkin
Aug 28, 2019·Epilepsy & Behavior Reports·Jonathan D SantoroTanuja Chitnis
Jan 26, 2021·Epilepsy & Behavior : E&B·Mary E Moya-MendezMohamad A Mikati
Aug 14, 2021·Neurotherapeutics : the Journal of the American Society for Experimental NeuroTherapeutics·Julie M ZiobroRenée A Shellhaas

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