Abstracts

Rationale: Refractory status epilepticus (RSE) has been well characterized as a serious neurological emergency with a high morbidity and mortality. Data regarding treatment options for patients who have failed traditional therapies are limited. A small number of case reports exists regarding use of ketamine in RSE in the literature. We describe our experience with ketamine in treatment of RSE over an eight-year period. Methods: Eleven adults with RSE who were treated with ketamine in addition to other antiepileptic drugs (AEDs) between 2003 and 2011 were identified using billing codes at discharge. All patients had failed initial treatment with benzodiazepines and weight-based intravenous loading doses of standard AEDs. Ketamine was given intravenously as a continuous infusion, typically after an initial bolus dose. Data were collected on age, gender, history of epilepsy, etiology of RSE, daily total dosing of ketamine, co-therapeutic agents, treatment response, and disposition. Results: RSE was successfully terminated in all 11 patients. Co-infused continuous anesthetic agents were able to be discontinued in 8/11 (73%) of patients within 72 hours. Ketamine was the last AED used prior to resolution of RSE in 7/11 (64%) cases. In the remaining four cases, one other AED was added after ketamine infusion had begun. While 7/11 (64%) of our patients required pharmacological vasopressor support prior to the initiation of ketamine, administration of ketamine was uniformly associated with decreased pressor support, and 6/7 (85%) patients were weaned from pressors during ketamine infusion. Favorable outcome as defined by discharge to home or inpatient rehabilitation facility was attained in 5/11 (45%) patients. No acute adverse effects were noted with either loading doses or continuous infusion of ketamine. Conclusions: These findings suggest that ketamine may be a useful adjunctive agent in the treatment of RSE, and may be specifically considered in patients whose treatment options for RSE are limited by hypotension.