Ketamine in the treatment of refractory and super-refractory status epilepticus: Experience from two centres.

Autor: García-Ruiz M; Neurology Department, Hospital Universitario Clínico San Carlos, Calle del Profesor Martín Lagos, S/N, Madrid 28040, Spain., Rodríguez PM; Epilepsy Unit, Neurology Department, Hospital Universitario Clínico San Carlos, Calle del Profesor Martín Lagos, S/N, Madrid 28040, Spain., Palliotti L; Neurology Department, Hospital Universitario Clínico San Carlos, Calle del Profesor Martín Lagos, S/N, Madrid 28040, Spain., Lastras C; Epilepsy Unit, Neurology Department, Hospital Universitario Clínico San Carlos, Calle del Profesor Martín Lagos, S/N, Madrid 28040, Spain., Romeral-Jiménez M; Epilepsy Unit, Neurology Department, Hospital Universitario Clínico San Carlos, Calle del Profesor Martín Lagos, S/N, Madrid 28040, Spain., Morales IG; Epilepsy Unit, Neurology Department, Hospital Universitario Clínico San Carlos, Calle del Profesor Martín Lagos, S/N, Madrid 28040, Spain; Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Calle de La Masó, 38, Madrid 28034, Spain. Electronic address: igmorales@salud.madrid.org., Rey CP; Neurology and Traumatology Unit, Intensive Care Department, Hospital Universitario Clínico San Carlos, Calle del Profesor Martín Lagos, S/N, Madrid 28040, Spain., Rodrigo-Gisbert M; Neurology Department, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain., Campos-Fernández D; Epilepsy Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain., Santamarina E; Epilepsy Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119, Barcelona 08035, Spain., Carbonell BP; Epilepsy Unit, Neurology Department, Hospital Universitario Clínico San Carlos, Calle del Profesor Martín Lagos, S/N, Madrid 28040, Spain.
Jazyk: angličtina
Zdroj: Seizure [Seizure] 2024 Apr; Vol. 117, pp. 13-19. Date of Electronic Publication: 2024 Jan 22.
DOI: 10.1016/j.seizure.2024.01.013
Abstrakt: Purpose: There is insufficient evidence on the management of refractory status epilepticus (RSE) and super-RSE (SRSE). Ketamine is a N-methyl-d-aspartate receptor antagonist in the treatment of these entities. Our objectives were to study the effectiveness and safety of ketamine in the treatment of adult patients with RSE and SRSE, to determine the factors that can influence the response to ketamine, and to explore its use in patients without mechanical ventilation.
Methods: Adult patients who had received intravenous ketamine for the treatment of RSE or SRSE at Hospital Universitario Clínico San Carlos (Madrid, Spain) or Hospital Universitari Vall d'Hebron (Barcelona, Spain) from 2017 to 2023 were retrospectively analysed.
Results: This study included 58 adult patients, mean (standard deviation) age 60.2 (15.7) years, of whom 41 (70.7 %) were male; 33 (56.9 %) patients responded to ketamine without recurrence, with a low rate of adverse effects (8.6 %). The presence of SRSE at the time of ketamine initiation (OR 0.287, p = 0.028) and the time elapsed between status epilepticus onset and ketamine administration (OR 0.991, p = 0.034) were associated with worse response to ketamine. Patients treated without mechanical ventilation had similar rates of response without recurrence (62.5% vs 56.9 %) and lower mortality (37.5% vs 53.5 %) compared to the overall group.
Conclusion: Ketamine is an effective drug with few adverse effects. Prompt administration should be considered in patients with RSE requiring anaesthesia, in patients with SRSE, and in patients with RSE who do not respond to standard antiseizure drugs and in whom mechanical ventilation is not advised.
Competing Interests: Declaration of competing interest Dr. Santamarina reports grants and personal fees from UCB Pharma, Esai, Esteve, Bial and Angelini Pharma outside the scope of the submitted work. The remaining authors have no conflict of interest.
(Copyright © 2024 British Epilepsy Association. All rights reserved.)
Databáze: MEDLINE
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