Enteral Ketamine: A Promising Treatment Option for Super-refractory Status Epilepticus Following Unsuccessful Intravenous Anesthesia Taper
Abstract number :
1.325
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2024
Submission ID :
1297
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Lalit Bansal, MD – Children's Mercy Hospital
Kailash Pawar, MD – Children's Mercy Hospital
Kostreva Julie, MD – Children's Mercy Hospital
Kshama Ojha, MD – Children's Mercy Hospital
Audrey Kennedy, PharmD, BCPS, CPPS – Children's Mercy Hospital
Ara Hall, MD – Children's Mercy Hospital
Lines Vargas, MD – Children's Mercy Hospital
Mohammad Ilyas, MD – Children's Mercy Hospital
Waseem Baig, MD – Children's Mercy Hospital
Ahmed Abdelmoity, MD – Children's Mercy Hospital
Rationale: A significant knowledge gap exists regarding the treatment of super-refractory status epilepticus (SRSE) once patients have failed intravenous anesthesia taper (IAT). SRSE is a neurological emergency that carries substantial morbidity and mortality. Prolonged intubation and mechanical ventilation can exacerbate morbidity. In children, SRSE occurs in 7.1% of patients presenting with clinical status epilepticus (SE), with a high mortality of 21.3%.1 This study investigates the use of enteral ketamine (EK) as an alternative treatment when IAT had failed.
Methods: We conducted a retrospective review of pediatric patients with SRSE who received EK after IAT failure. We collected patient demographics, seizure type, frequency, and antiseizure interventions. Additionally, we recorded the duration of SE before starting EK, patient response, and side effects related to EK. Intubation duration (pre- and post-EK) was also documented. EK was administered enterally using the parenteral formulation (100mg/mL, Pfizer).
Results: Six patients (age 3-18 years) received EK; five of them were females. The mean duration of SE before starting EK was 489 hours (20 days; range 155 – 876 hours). On average, 8.33 (range 4-11) antiseizure interventions had previously failed, including a median of 2 (range 1-4) IAT. EK was initiated at 1.5-3 mg/kg/day, with dose adjustments every 1-3 days based on response and tolerance. All patients responded positively, achieved resolution without SE recurrence. Four patients receiving anesthetic drips successfully transitioned to IAT within 3-50 hours of initiating EK. Extubation occurred successfully in all patients within 2-18 days of EK initiation. No significant side effects were observed, and all patients reported improved attention. The mean duration of EK use was 72.8 days (range 28-115 days), with a dose range of 2-7 mg/kg/day. Following the EK taper, no change in seizure frequency was noted.
Conclusions: Enteral ketamine appears to be a safe and effective alternative treatment for SRSE when IAT has been unsuccessful. Its use may help reduce morbidity and mortality associated with SRSE. EK can be conveniently initiated in an inpatient setting and transitioned to outpatient settings for short-term use. We recommend considering EK as a treatment option in SRSE protocols following IAT failure and encourage further validation through multicenter studies and large population cohorts.
Reference
< !1. Kravljanac R, Djuric M, Jankovic B and Pekmezovic T. Etiology, clinical course and response to the treatment of status epilepticus in children: a 16-year single-center experience based on 602 episodes of status epilepticus. european journal of paediatric neurology. 2015; 19(5): 584-590.
Funding: None
Clinical Epilepsy