Efficacy and safety of ketamine in refractory status epilepticus in children

Anna Rosati, Manuela L'Erario, Lucrezia Ilvento, Costanza Cecchi, Tiziana Pisano, Lorenzo Mirabile, Renzo Guerrini

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To evaluate the efficacy and safety of ketamine (KE) in themanagement of refractory convulsive status epilepticus (RSE) in children. Methods: In November 2009, we started using KE for treating all children consecutively referred for RSE. Clinical and treatment data were analyzed. Results: Between November 2009 and June 2011, 9 children with RSE received IV KE. In 8 patients, SE had persisted for more than 24 hours (super-refractory RSE), with a median of 6 days (mean 8.5 ± 7.5; range 2-26 days). Prior to KE administration, conventional anesthetics were used, including midazolam, thiopental, and propofol in 9, 5, and 4 patients each. Median dose of KE in continuous IV infusion was 40 gamma(μg)/kg/min (mean 36.5 ± 18.6 gamma[μg]/kg/min; range 10-60 gamma [μg]/kg/min). Midazolam was administered add-on to prevent emergence reactions. The use of KE was associated with resolution of RSE in 6 children. None of the patients experienced serious adverse events. Among the 3 individuals who did not respond to KE, 2 were cured by surgical removal of epileptogenic focal cortical dysplasia. Conclusion: In this small, open-label, unblinded series with no concurrent control group, KE appears effective and safe in treating RSE in children. Larger, randomized studies are needed to confirmdata emerging from this preliminary observation. Classification of evidence: This study provides Class IV evidence that IV KE can be effective in treating children with RSE (no statistical analysis was done).

Original languageEnglish
Pages (from-to)2355-2358
Number of pages4
JournalNeurology
Volume79
Issue number24
DOIs
Publication statusPublished - Dec 11 2012

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

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