Enteral Ketamine for Status Epilepticus in Children with Epilepsy
Laura DiDomenico1, Lisa C Garrity2, Kelsey E Poisson3
1Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Enteral ketamine effectively treated status epilepticus (SE) in children, reducing seizure frequency and potentially preventing intubation. This study highlights its safety and efficacy in pediatric epilepsy cases.
Area of Science:
- Pediatric Neurology
- Epileptology
- Pharmacology
Background:
- Status epilepticus (SE) affects 10-20% of children with epilepsy.
- Children with seizure clusters face a higher risk of SE.
- Ketamine use for SE is increasing in pediatric populations.
Purpose of the Study:
- To evaluate the efficacy and safety of enteral ketamine.
- To assess treatment for convulsive status epilepticus (CSE) with refractory seizure clusters.
- To examine treatment for nonconvulsive status epilepticus (NCSE) in children with epilepsy.
Main Methods:
- Retrospective chart review of pediatric patients (1-21 years) with SE treated with enteral ketamine.
- Data collected between September 2021 and September 2022 at a pediatric tertiary care center.
- Assessed seizure resolution/reduction, intubation, hospitalization duration, side effects, and readmissions.
Main Results:
- Nine patients (2-21 years) with epilepsy and SE were identified.
- Seven patients showed seizure resolution or reduction within 48 hours of ketamine.
- Two patients required intubation; hospitalization varied, with some readmissions showing shorter stays.
Conclusions:
- Enteral ketamine appears effective and well-tolerated for pediatric SE (CSE and NCSE).
- It may help prevent intubation and reduce hospitalization time in children with epilepsy.
- The treatment shows promise, particularly for genetic epilepsies.
Background:
Approximately 10% to 20% of children with epilepsy experience status epilepticus (SE), and children with seizure clustering are at higher risk. Ketamine is growing in use for SE. This study examines the efficacy and safety of enteral ketamine in the treatment of convulsive status epilepticus (CSE) characterized by refractory seizure clusters and nonconvulsive status epilepticus (NCSE) in children with epilepsy.
Methods:
Patient charts were reviewed retrospectively. Children with epilepsy aged one to 21 years presenting in SE and treated with enteral ketamine between September 1, 2021 and September 1, 2022 at a pediatric tertiary care center were identified. Resolution or reduction in seizure frequency within 48 hours, clinical presentation, endotracheal intubation, hospitalization duration, side effects, and readmission were assessed.
Results:
Nine patients aged two to 21 years were identified. Six patients presented in CSE characterized by recurrent seizures, and three patients presented in NCSE. Five patients had genetic epilepsies, including PCDH19- and MECP2-related epilepsy. Seven patients had resolution or reduction in seizures within 48 hours of ketamine initiation. Two patients were intubated. Hospitalization duration ranged from one to 34 days. Three patients reported side effects. Three patient readmissions with early ketamine treatment had equal or shorter hospitalizations.
Conclusions:
Enteral ketamine may prove an effective, well-tolerated option for treatment of convulsive and nonconvulsive SE in children with epilepsy, including genetic epilepsies, and may prevent intubation and shorten hospitalization time.
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