Efficacy and safety of ketamine in refractory status epilepticus in children

Abstract

This study provides Class IV evidence that IV KE can be effective in treating children with RSE (no statistical analysis was done).

Etiology, clinical course and response to the treatment of status epilepticus in children: A 16-year single-center experience based on 602 episodes of status epilepticus

“…Recent open-label, uncontrolled study provides Class IV evidence that intravenous ketamine might be effective and safe in treating children with RefSE. 12 In our study, ketamine was ineffective given through gastric tube in two cases without co-medication with intravenous midazolam. Recently published data suggested that some non-medication treatment such as ketogenic diet 13 or urgent surgical treatment 14 could be helpful in terminating RefSE in children, but none of our cases were treated by them.…”

Ketamine for the treatment of refractory status epilepticus

“…When ketamine is selected for RSE treatment following prolonged SE, it maybe typically suitable after 5-6 anticonvulsants have been found to be ineffective. This treatment choice is summarized from previous successful reports [25,26,29], and the rationale for its use is based on prolonged seizure duration, decreased numbers of active GABA receptors, gradual elevation of NMDA receptor activity, and increased numbers of NMDA receptors [14][15][16]54,55].…”

“…Moreover, Synowiec et al [30] found that a bolus dose of 1-2 mg/ kg, followed by maintenance at an infusion rate of 1.3 mg/kg/h (range 0.45-2.1 mg/kg/h) for 9.8 days (range 4-28 days), resulted in a successful seizure control rate of 100% (11/11). When ketamine is administered to children, we recommend a 2-3 mg/ kg bolus of ketamine every 5 min for a total of 2 administrations, followed by maintenance at a rate of 40 mg/kg/min (range 10-60 mg/kg/min) for 6.7 days (range 3-17 days) [26]. (2) Intravenous infusion: Zelier et al [31] performed continuous infusion of ketamine at 10-40 mg/kg/min for the treatment of RSE, and the seizures in all of the patients were ultimately effectively controlled (2/2).…”

Treatment of Super-Refractory Status Epilepticus

“…The bolus dose is between 0.5 and 3 mg/kg. The infusion rate varies between 1 and 10 mg/kg/h, with no effect noted below 0.75 mg/kg/h [15,17]. The duration for treatment varies between intermittent boluses and continuous infusions for up to 27 days [14, 18•].…”

“…Ketamine has been associated with tachycardia and acute elevation in blood pressure, all of which resolve after discontinuation of the drug [15,17]. It may also increase intracranial pressure (ICP), especially in unstable patients that cannot autoregulate.…”