Abstract Details

Title Outcomes of Ketamine Use in Refractory Status Epilepticus in the Neuroscience Intensive Care Unit

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 036

Objective To describe the clinical characteristics and outcomes of patients with refractory status epilepticus (RSE) treated with ketamine (KE).

Background Status epilepticus (SE) is a neurologic emergency. RSE is defined as recurrent seizure activity despite two appropriately selected and dosed anti-seizure medications (ASMs), including benzodiazepines. Studies have shown that recurring seizures cause internalization of GABA-A receptors and mobilization of excitatory NMDA receptors. Hence, traditional anesthetics acting on GABA-A receptors would be less effective, making higher doses necessary. In this scenario, NMDA modulating medication, such as KE, represent an attractive treatment alternative for RSE. Experimental models have shown the use of valproate and ketamine in addition to diazepam to have a synergistic effect that targets receptor changes and controls benzodiazepine-RSE.

Design/Methods Retrospective cohort study in the only academic medical center in Mississippi.

Results A total of 14 patients admitted to the neuroscience intensive critical care unit with electro-physiologic and clinical diagnosis of RSE were treated with KE over a period of 4 years from 2015-2019. Patients were treated with 5±1 ASMs prior to KE, which were continued during KE administration. KE was administered 70±53 hours from the onset of SE, with an initial bolus dose of 1.3±0.7 mg/kg/hr and infusion rate of 2.1±1.4 mg/kg/hr. It was administered for 35±28 hours, with a final infusion rate before seizure cessation of 3.3±2.9 mg/kg/hr. KE administration caused seizure cessation in 71.4% patients. Adverse effects reported in 23.1% patients included hypotension, renal tubular acidosis, and abdominal compartment syndrome. Responders to KE (n=10) had lower GCS scores, more abnormal motor exams, unfavorable STESS, delay in initiating KE infusion, longer duration of KE administration, and a higher mortality rate. Overall, KE was well tolerated and efficacious in the treatment of RSE.

Conclusions Overall, KE was well-tolerated and achieved seizure cessation in 71.4% of our patients.

Authors/Disclosures
Khoula Saleem PRESENTER	Ms. Saleem has nothing to disclose.
Prashant Natteru, MBBS (Mayo Clinic Health System)	Dr. Natteru has nothing to disclose.
Christa O'hana S. Nobleza, MD	Dr. Nobleza has nothing to disclose.

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