Ketamine for Refractory Status Epilepticus: A Systematic Review
Anna Rosati1, Salvatore De Masi2, Renzo Guerrini3
1Neuroscience Department, Children's Hospital Anna Meyer, University of Florence, Viale Pieraccini 24, 50139, Florence, Italy.
CNS Drugs
|September 21, 2018
Summary
Ketamine shows promise as a third-line treatment for refractory status epilepticus, particularly when administered early. Further trials are needed to confirm its efficacy and safety compared to traditional anesthetics.
Area of Science:
- Neurology
- Pharmacology
Background:
- Refractory status epilepticus (RSE) is a critical neurological emergency.
- Ketamine is an emerging third-line treatment option for RSE.
- Ketamine offers potential advantages over conventional anesthetics due to its pharmacological profile.
Purpose of the Study:
- To evaluate the efficacy and safety of ketamine for treating RSE in pediatric and adult patients.
- To synthesize existing evidence on ketamine's use in RSE management.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov.
- The review included case reports and case series, as randomized controlled trials were unavailable.
- Data from 27 case reports (30 individuals) and 14 case series (248 individuals, including 29 children) were analyzed.
Main Results:
- Ketamine demonstrated an efficacy rate of 64% for RSE treated within 3 days, decreasing to 32% for RSE lasting over 26 days.
- Early administration of ketamine was associated with twice the effectiveness.
- Endotracheal intubation was avoided in 12 patients (10 children), particularly those with non-convulsive status epilepticus treated with oral ketamine.
Conclusions:
- Ketamine is effective for treating refractory status epilepticus, but current evidence is limited by methodological constraints.
- Ongoing studies and future clinical trials are crucial to validate ketamine's efficacy and safety profile.
- Ketamine may represent a valuable third-line therapeutic option for RSE in both pediatric and adult populations.
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