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Ketamine for medically refractory status epilepticus after elective aneurysm clipping
F A Zeiler1, A M Kaufmann, L M Gillman
1Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada. umzeiler@cc.umanitoba.ca
Neurocritical Care
|May 25, 2013
Summary
Refractory status epilepticus (RSE) after aneurysm clipping is rare. Early ketamine administration rapidly controlled seizures in two patients, leading to recovery.
Area of Science:
- Neurology
- Neurosurgery
- Critical Care Medicine
Background:
- Medically refractory status epilepticus (RSE) following elective aneurysm clipping is a rare neurological emergency.
- Identifying the cause of RSE in this context is often challenging, with no clear structural, vascular, infectious, or metabolic etiology found in these cases.
Observation:
- Two patients developed RSE post-craniotomy for elective aneurysm clipping.
- Initial treatments with multiple anti-epileptic drugs and intravenous sedatives failed to control seizures for weeks.
Findings:
- Ketamine, administered at 20 and 40 mg/kg/min, rapidly achieved burst suppression within hours in both patients.
- All anti-epileptic and sedative medications were successfully tapered within a month following ketamine initiation.
Implications:
- Early consideration of ketamine may be beneficial for managing RSE post-aneurysm clipping when standard treatments fail.
- Patients achieved cognitive recovery, with residual morbidity primarily related to critical care polyneuropathy.
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