Ketamine reduces seizures in refractory status epilepticus, Finds study

Ayham Alkhachroum and associates from the Departments of Neurology and Neurosurgery, Columbia University, New York, NY; and Departments of Critical Care Medicine and Clinical Neurosciences, University of Calgary, Canada conducted the study to test the ketamine infusion efficacy in the treatment of super-refractory status epilepticus (SRSE).

We also studied the effect of high doses of ketamine on brain physiology as reflected by invasive multimodality monitoring (MMM), the authors described.

The researchers studied a consecutive series of 68 patients with a Mean age of 53 ± 18 years and those with SRSE who were admitted between 2009 and 2018, treated with ketamine, and monitored with scalp EEG. Out of the total sample, 46% of patients were female. Eleven of these patients underwent MMM at the time of ketamine administration. We compared patients who had seizure cessation after ketamine initiation to those who did not, they further added.

2.2 ± 1.8 mg/kg/h was the average dose of ketamine infusion, with a median duration of 2 days. However, the average dose of midazolam was 1.0 ± 0.8 mg/kg/h at the time of ketamine initiation and was started at a median of 0.4 days before ketamine.

Based on the methodology, the following findings were deduced-

1. There was at least 50% decrease in the seizure burden within 24 hours of starting ketamine in 81% of the patients, while complete cessation was observed in 63% of patients.
2. Ketamine was associated with stable mean arterial and with decreased vasopressor requirements over time.
3. There was no effect on intracranial pressure, cerebral blood flow, or cerebral perfusion pressure.

As a result, the researchers concluded that "the data supports the notion that high-dose ketamine infusions are associated with decreased vasopressor requirements without increased intracranial pressure. Ketamine treatment was associated with a decrease in seizure burden in patients with SRSE."