Ketamine Infusion for Refractory Status Epilepticus-A Tale of Two Patients

Area of Science:

• Palliative Care
• Neurology
• Critical Care Medicine

Background:

• Seizures are a common and distressing symptom at the end of life.
• Refractory status epilepticus poses significant challenges when conventional antiepileptic drugs fail.

Purpose of the Study:

• To evaluate the efficacy of parenteral ketamine infusion for managing refractory status epilepticus in terminally ill patients.
• To explore ketamine as a viable alternative treatment in palliative care settings.

Main Methods:

• Case report of two terminally ill patients with refractory status epilepticus.
• Administration of parenteral ketamine infusion at a dose of 1 mg/kg/hour for seizure control.

Main Results:

• Successful seizure control was achieved in both patients using parenteral ketamine infusion.
• Ketamine infusion was initiated in the general ward for one patient, demonstrating potential for non-ICU management.
• This treatment was effective despite failure of standard antiepileptic protocols.

Conclusions:

• Parenteral ketamine infusion shows promise as an effective treatment for refractory status epilepticus in palliative care.
• Ketamine may allow for seizure management on general wards, aligning with patient goals of care and avoiding ICU transfer.
• Further research is warranted to validate ketamine's role in managing terminal refractory status epilepticus.