Starting ketamine for neuroprotection earlier than its current use as an anesthetic/antiepileptic drug late in refractory status epilepticus

Epilepsia
Denson G Fujikawa

Abstract

Ketamine is currently being used as an anesthetic/antiepileptic drug in refractory status epilepticus. To validate its use, 2 clinical trials are recruiting patients. However, preclinical studies of its use in chemically induced status epilepticus in rodents have shown that it is remarkably neuroprotective, through N-methyl-d-aspartate-receptor blockade, even when given after the onset of status epilepticus. Human studies have shown that status epilepticus-induced brain damage can be caused by a glutamate analogue and that it occurs in the same brain regions as in the animal studies. We therefore propose that ketamine be started early in the course of human status epilepticus as a neuroprotectant and that it be continued until epileptic discharges are eliminated. Using it as an anesthetic/antiepileptic drug late in the course of refractory status epilepticus only ensures that it is given after widespread brain damage has occurred.

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Citations

Apr 21, 2020·Expert Review of Neurotherapeutics·Yin YanXuefeng Wang
Apr 21, 2020·Anesthesiology Research and Practice·Abby PribishArun Kalava
Sep 6, 2020·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Suchitra Joshi, Howard P Goodkin
Nov 1, 2020·Pediatric Blood & Cancer·Satya PrakashRachna Seth
Jan 11, 2021·Korean journal of anesthesiology·Abhijit Kumar, Amit Kohli
Jul 11, 2020·Case Reports in Neurology·Zina H StavitskyJames Martin Johnston
Jun 14, 2021·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Alejandra VasquezUNKNOWN Pediatric Status Epilepticus Research Group (pSERG)

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