Abstracts

Rationale: Intravenous ketamine has increasingly been reported to be efficacious in the treatment of refractory status epilepticus (RSE) through various case reports and small case series. Large single center experiences of its utility in RSE are lacking. We report our experience with ketamine administration and its efficacy for management of RSE in a single neurocritical care unit.Methods: A retrospective analysis of intravenous ketamine administered between 2006 and 2013 as part of the treatment regimen for RSE, defined as persistent seizure after the administration of 2 antiepileptic drugs (AEDs), was completed. Patient demographics, patient history, clinical course, EEG data, and patient outcomes were recorded in a systemic fashion. Electronic medication records were reviewed for time of ketamine initiation, total dosage, and concomitant use of other anesthetics and AEDs. Response to ketamine was defined as permanent control of SE when ketamine was the last anesthetic added and withdrawal of ketamine did not result in recurrence of SE. Outcomes were measured by Glasgow Outcome Scale (GOS).Results: A total of 63 episodes of RSE were included; 49.2% (31/63) of which occurred in women with mean age of 57.67 (Range, 21-88). Two thirds of the patients (42/63) had no prior history of epilepsy. On an average, RSE duration was 3.01 days (Range, 0-35 days) prior to initiation of ketamine. Early initiation of ketamine (within 48 hours) was seen in 41 patients (65%), intermediate initiation within 7 days was seen in 13 (20.6%), and late initiation was seen in 9 (14.2%). Variable ketamine loading doses were given in 58.7% of cases (37/63). Median initial Infusion rate of ketamine was 1mg/kg/hr after loading dose was given in and median maximum infusion rate reached was 2.45mg/kg/hr. Patients were maintained on ketamine from 1 days to 54 days (median =4; Avg= 6.8 days). Adverse events were attributed to prolonged sedation and intubation with no adverse events reported specific to ketamine. Ketamine response was seen in 52/63 patients (80.95%) and overall cessation of status by all drugs was achieved in 62 patients. Good outcome (GOS 4,5) was achieved in 18 patients.Conclusions: We provide a single center retrospective data on the use of ketamine in RSE. Our study population consisted of adult patients with mostly de novo epilepsy. Although traditionally, ketamine’s unique NMDA receptor blockade has been advocated in prolonged SE due to enhancement of glutamatergic excitation; in our report, Ketamine was administered relatively early with most patients receiving ketamine within 48 hours of SE. Ketamine was safe without any specific complication attributed to it. It was effective in 82.53% of patients.