Ketamine Continuous Infusion for Refractory Status Epilepticus in a Patient With Anticonvulsant Hypersensitivity Syndrome

Esaian, Diana; Joset, Danielle; Lazarovits, Candace; Dugan, Patricia; Fridman, David

doi:10.1177/1060028013505427

Cited by 14 publications

(12 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although not FDA approved for the management of SE, ketamine has been described as an adjunctive agent in patients unable to attain seizure control with benzodiazepines, such as midazolam, or propofol. [2][3][4][5][6][7][8][9][10] To the best of our knowledge, the use of ketamine as an adjunct to barbiturate coma has not been reported in literature. In the following cases, we describe using continuous ketamine in combination with pentobarbital to achieve seizure control and decrease the dose and duration of pentobarbital coma.…”

Section: Introductionmentioning

confidence: 74%

“…1,11,12 Published case reports and case series describe successful use ketamine infusions to augment the action of continuous antiepileptic drugs, such as midazolam and propofol, in RSE. [2][3][4][5][6][7][8][9][10] In a recent systematic review on the effectiveness of NMDA receptor antagonists in RSE, ketamine was noted to achieve a positive response in 56.5 % adult patients. Adverse events related to ketamine in these patients were rare.…”

Section: Discussionmentioning

confidence: 97%

“…[2][3][4][5][6][7][8][9][10] Ketamine acts synergistically to slow excitatory neurotransmission by altering NMDA receptors that are up-regulated in RSE, which are unaffected by escalating doses of benzodiazepines, barbiturates, or propofol. 1,11,12 Published case reports and case series describe successful use ketamine infusions to augment the action of continuous antiepileptic drugs, such as midazolam and propofol, in RSE.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10] Ketamine acts by antagonizing N-methyl-D-aspartate (NMDA) receptors, which may be up-regulated in RSE and contribute to prolonged seizure activity and medication resistance. Although not FDA approved for the management of SE, ketamine has been described as an adjunctive agent in patients unable to attain seizure control with benzodiazepines, such as midazolam, or propofol.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Use of Ketamine in Barbiturate Coma for Status Epilepticus

McGinn

Bishop

Sarwal

2016

Clinical Neuropharmacology

View full text Add to dashboard Cite

These cases demonstrate that ketamine may show promise as an adjunct to induced pentobarbital coma for refractory SE. Adjunctive use of ketamine may reduce the dose and duration of pentobarbital required, hence preventing complications associated with barbiturate therapy. Future studies are needed to define the optimal dose, timing, and role of ketamine infusions in the management of refractory SE.

show abstract

Section: Introductionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Use of Ketamine in Barbiturate Coma for Status Epilepticus

McGinn

Bishop

Sarwal

2016

Clinical Neuropharmacology

View full text Add to dashboard Cite

show abstract

“…Case reports suggest the efficacy of IV ketamine infusion even in cases where traditional GABAergic anesthetics fail. [50][51][52] Ketamine has theoretical advantages, including its potential to be neuroprotective via modulation of N-methyl-D-aspartate (NMDA) activity and its lack of cardiovascular side effects. 48 A multicenter retrospective study concluded that ketamine infusion was safe and potentially efficacious when administered via a loading dose followed by a continuous infusion.…”

Section: Refractory Status Epilepticus and Superrefractory Status Epimentioning

confidence: 99%

Current Trends in Treatment of Status Epilepticus and Refractory Status Epilepticus

Betjemann

2015

Semin Neurol

View full text Add to dashboard Cite

Status epilepticus (SE) represents a common neurologic emergency that if not treated appropriately and in a timely fashion can lead to significant neurologic injury and mortality. A heterogeneous disorder, SE is often organized into major categories, including generalized convulsive SE (GCSE), focal motor SE, nonconvulsive SE (NCSE), and refractory SE. The treatment of SE and outcomes are often dictated by which type of SE a patient is experiencing, the age of the patient, and the underlying etiology. Despite significant advances in research, practice patterns vary and controversy remains regarding the most appropriate treatment of the various forms of SE. Epidemiology and PrognosisWhen broadly defined as a seizure lasting more than 30 minutes or recurrent seizures with incomplete return to baseline, the annual incidence of SE ranges from 10 to 41 per 100,000 persons, or roughly 125,000 to 195,000 new cases annually in the United States. 1-5 These figures may even be underestimates, particularly in the case of NCSE, which is only diagnosed through electroencephalographic (EEG) monitoring; recent studies of inpatient EEG monitoring, particularly in the intensive care unit (ICU), have demonstrated high rates of electrographic seizures that likely are underrecognized. 6-11 Owing in part to this increase in SE detection in the hospital, the incidence of SE is increasing. 12,13 Although greatly influenced by the etiology, overall mortality estimates related to SE approach 20% 1 and are not changing dramatically over time. 12,13 When considering the causes of SE, it can be helpful to divide cases into acute and chronic etiologies. Acute symptomatic causes (i.e., stroke, metabolic, infectious, anoxic injury) tend to be more common than chronic causes (i.e., low antiepileptic drug level, alcohol abuse, tumor, remote effects from stroke) and are generally associated with a higher mortality. 2,5,14 Given the increasing Keywords ► seizures ► status epilepticus ► refractory status epilepticus ► epidemiology ► prehospital treatment ► diagnostic evaluation AbstractStatus epilepticus is a heterogeneous disorder with varied definitions and presentations. Taken together, all forms of status epilepticus carry significant morbidity and mortality, much of which is dictated by the underlying etiology. Generalized convulsive status epilepticus, which represents a common form, is a true neurologic emergency that requires emergent management. Treatment focuses on stabilizing the patient and aggressive medical management to achieve the timely termination of seizures. For other forms of status epilepticus including nonconvulsive and focal status epilepticus, the goal remains early seizure termination, but the use of intravenous medications should be weighed against the risks associated with these therapies. The diagnostic evaluation of status epilepticus is guided by the patient's history and should be broad, including a screen for toxins, electrolytes, structural abnormalities, and central nervous system infectious and autoimmune/inflam...

show abstract

Drugs Commonly Used to Treat Refractory Status Epilepticus in Clinical Practice

Wang

2017

Refractory Status Epilepticus

View full text Add to dashboard Cite

Ketamine Continuous Infusion for Refractory Status Epilepticus in a Patient With Anticonvulsant Hypersensitivity Syndrome

Abstract: This is the first case report to describe a successful transition to a ketamine infusion in a patient with AHS and transaminitis.

Cited by 14 publications

References 33 publications

Use of Ketamine in Barbiturate Coma for Status Epilepticus

Use of Ketamine in Barbiturate Coma for Status Epilepticus

Current Trends in Treatment of Status Epilepticus and Refractory Status Epilepticus

Drugs Commonly Used to Treat Refractory Status Epilepticus in Clinical Practice

Contact Info

Product

Resources

About