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Ketamine for refractory status epilepticus: a case of possible ketamine-induced neurotoxicity
Eroboghene E Ubogu1, Stephen M Sagar, Alan J Lerner
1Department of Neurology, University Hospitals of Cleveland, Hanna House 5th Floor, 11100 Euclid Avenue, Cleveland, OH 44106-5040, USA.
Abstract:
A 44-year-old man with treated neurosyphilis presented with subclinical status epilepticus (SE) refractory to intravenous high-dose lorazepam, phenytoin, and valproic acid over 4 days. Ketamine infusion was instituted after low-dose propofol sedation with gradual control of electrographic seizures over 72h. Reevaluation 3 months later revealed diffuse cerebellar and worsened cerebral atrophy, consistent with animal models of N-methyl-D-aspartate antagonist-mediated neurotoxicity. Animal studies of prolonged ketamine therapy are required before widespread human use in SE.