Abstracts

Non-convulsive status epilepticus (NSCE) is not an uncommon problem in paediatric patients with refractory epilepsy. Standard treatments include steroids, benzodiazepines and the ketogenic diet but response to these treatments is variable and side effects common. A recently published small case series report suggested ketamine, a non-competative NMDA receptor antagonist, may have a role in the treatment of NSCE. We report our prelimenary findings in the use of oral ketamine for NSCE. Subsequent to the recently published paper we are carrying out a prospective audit in our use of oral ketamine. Patients were selected on the basis of clinical and electrophysiological findings, all had an unequivocal diagnosis of NSCE prior to starting therapy. Oral ketamine was prescribed (0.75mg/kg twice daily for 5 days), the first dose being administered under supervision. All patients had a clinical and EEG re-evaluation on day 5 of treatment. A total of 7 pateints (2 male) with a mean age of 7.4 years fulfilled the criteria. Diagnoses were different in all 7 patients and included Lennox Gastaut Syndrome, unclassified myoclonic epilepsy, symptomatic generalised epilepsy and Landau Kleffner varient with recurrent epileptic encephalopathy. 7/7 had previously had episodes of NSCE (range 1-8 episodes) and all had received at least one course of steroids in the past with variable response. 1 patient developed a steroid myopathy following repeated steroid administration and 2 patients reported significant mood and behavioural disturbances. 4/7 patients had an excellent clinical and EEG response to following ketamine administration with a rapid improvement in cognitive function and an improvement in EEG findings. 2 patients relapsed back into NSCE immeadiately after ketamine was discontinued at day 5. Both showed a clinical and electrophysiological improvement after ketamine was re-introduced. 2 patients did not show any response to ketamine. There were no reported adverse during or after ketamine administration including 2 patients maintained on ketamine for longer than 2 months. Ketamine appears to be an effective and well tolerated alternative to steroids and benzodiazepines in the management of non-convulsive status epilepticus. Further studies are required to assess its efficacy and safety compared with standard treatments.