Ketamine decreases seizure burden in super-refractory status epilepticus
Super refractory status epilepticus (SRSE) is one of the most challenging disorders to treat in the neurointensive care unit. Often, clinicians must resort to less-established treatments with regards to efficacy and safety. A recent study suggests Ketamine treatment was associated with a decrease in seizure burden in patients with SRSE. The research has been published in the journal Neurology on October 20, 2020.
Super-refractory status epilepticus (SRSE) is specified by ongoing or recurring clinical or electroencephalographic seizure activity 24 h or more after initiation of anesthetic treatment. Ketamine (KET) has a strong antagonistic effect on the NMDA–glutamate receptor. Its half-life is 2–3 h, and KET undergoes extensive hepatic metabolism. Animal models (hippocampal electrical stimulation or pilocarpine animal models) have demonstrated the efficacy of KET in refractory status epilepticus (RSE) in rats, even in late stages, when GABA-ergic drugs have failed. The most significant adverse effects of KET are hallucinations and sympathetic adrenergic effects. To test ketamine infusion efficacy in the treatment of super-refractory status epilepticus (SRSE), researchers evaluated the patients with SRSE who were treated with ketamine. They further assessed the effect of high doses of ketamine on brain physiology as reflected by invasive multimodality monitoring (MMM).
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