Abstracts

Rationale: Refractory status epilepticus (RSE) is defined as a status epilepticus (SE) not responding to first- and second-line antiepileptic drug (AED) therapies. Ketamine (KET) is a noncompetitive NMDA receptor antagonist, which has been recommended in RSE, based on few small retrospective case series.. We aimed to evaluate the safety and efficacy of KET in RSE. Methods: We included all patients with SE (n=219) treated in our neurological intensive care unit from 2011 to 2013. We retrospectively analysed aetiology, duration and type of SE, daily dose of, co-therapeutic agents, treatment response and disposition of all patients, who were treated with KET during this period. Results: In 26/219 patients (median age 64.5 years; range 15-80 at time of SE) with SE, Ketamine S in combination with Midazolam was used. In all 26 patients, initial treatment with standard AED failed. RSE causes: 8/26 post-anoxic, 4/26 systemic infection, 4/26 stroke/intracerebral haemorrhage, 6/26 unknown, 4/26 pre-existing epilepsy. RSE types: 2/26 myoclonic SE, 5/26 convulsive SE (CSE), 15/26 nonconvulsive SE (NCSE), 3/26 CSE evolving in NCSE, 1/26 focal SE evolving in NCSE. Median time of SE before KET initiation was 3.5 days (range 1-20); Median duration of KET treatment were 5 days (range 1-16); 96 hours (range 8-355). Six patients were started with a median bolus of 200 mg (range 200-300), followed by continuous infusion; 20 patients received continuous infusion (median 200 mg/h, range 50-375). Median dose of was 1.91 mg/kg/h (range 0.11-4.68); 150 mg/h (range 12.5-375). RSE was successfully terminated in 12/26 patients, however 14/26 patients died either due to RSE or their main disease despite terminated SE. Conclusions: KET may be effective in later stages of SE when adequate first and second line treatments fail, but overall outcome remains poor with a 70% in hospital mortality.