This study was presented in part at the 2012 Annual Meeting of the American Epilepsy Society in San Diego, CA.
Full-Length Original Research
Intravenous ketamine for the treatment of refractory status epilepticus: A retrospective multicenter study
Version of Record online: 12 JUN 2013
Wiley Periodicals, Inc. © 2013 International League Against Epilepsy
Volume 54, Issue 8, pages 1498–1503, August 2013
How to Cite
Gaspard, N., Foreman, B., Judd, L. M., Brenton, J. N., Nathan, B. R., McCoy, B. M., Al-Otaibi, A., Kilbride, R., Fernández, I. S., Mendoza, L., Samuel, S., Zakaria, A., Kalamangalam, G. P., Legros, B., Szaflarski, J. P., Loddenkemper, T., Hahn, C. D., Goodkin, H. P., Claassen, J., Hirsch, L. J., LaRoche, S. M. (2013), Intravenous ketamine for the treatment of refractory status epilepticus: A retrospective multicenter study. Epilepsia, 54: 1498–1503. doi: 10.1111/epi.12247
- Issue online: 30 JUL 2013
- Version of Record online: 12 JUN 2013
- Manuscript Accepted: 9 MAY 2013
- Pfizer's Medical and Academic Partnerships Program
- SickKids Foundation
- Fundación Alfonso Martín Escudero
- UCB Pharma
- American Academy of Neurology
- David-Phinney Foundation/Sunflower Revolution
- University of Cincinnati Research Council
- Canadian Institutes of Health Research
- PSI Foundation
- Refractory status epilepticus;
- Antiepileptic drugs
To examine patterns of use, efficacy, and safety of intravenous ketamine for the treatment of refractory status epilepticus (RSE).
Multicenter retrospective review of medical records and electroencephalography (EEG) reports in 10 academic medical centers in North America and Europe, including 58 subjects, representing 60 episodes of RSE that were identified between 1999 and 2012. Seven episodes occurred after anoxic brain injury.
Permanent control of RSE was achieved in 57% (34 of 60) of episodes. Ketamine was felt to have contributed to permanent control (“possible” or “likely” responses) in 32% (19 of 60) including seven (12%) in which ketamine was the last drug added (likely responses). Four of the seven likely responses, but none of the 12 possible ones, occurred in patients with postanoxic brain injury. No likely responses were observed when infusion rates were lower than 0.9 mg/kg/h, when ketamine was introduced at least 8 days after SE onset, or after failure of seven or more drugs. Ketamine was discontinued due to possible adverse events in five patients. Complications were mostly attributed to concurrent drugs, especially other anesthetics. Mortality rate was 43% (26 of 60), but was lower when SE was controlled within 24 h of ketamine initiation (16% vs. 56%, p = 0.0047).
Ketamine appears to be a relatively effective and safe drug for the treatment of RSE. This retrospective series provides preliminary data on effective dose and appropriate time of intervention to aid in the design of a prospective trial to further define the role of ketamine in the treatment of RSE.