Objective: To determine the efficacy and safety of ketamine (KE) in the management of refractory status
epilepticus (RSE) in adults.
Study Design: Open Label, unblinded prospective case series.
Place and Duration of Study: The study was conducted at Neurology Department Military Hospital Rawalpindi, from Jan 2014 to Dec 2014.
Material and Methods: All the patients with status epilepticus, from Jan 2014 to Dec 2014 were treated with ketamine in addition to benzodiazepines, phenytoin and levitricetam. Ketamine was the last drug added and if seizures were still not controlled then anesthetic agents like thiopental and propofol were used.
Results: Between Jan 2014 and Dec 2014, twenty patients received IV Ketamine. In 18 patients RSE lasted for more than 24 hours, with a median of 4 days (range 1-8 days). Mean duration of seizures in the study group was 4.45 days (SD 2.01). Ketamine was successful in terminating seizure activity in 40% (n=8) patients while it failed in 15% (n=3) patients. There was additional 15% (n=3) partial response in the form of initial control but these patients had later breakthrough or with drawl seizures. Twenty five percent (n=5) of the patients died during the treatment while in one patient ketamine had to be stopped because of intolerable side effects. In our patients the adverse effects of ketamine included sepsis (35%, 5, n=7), shock (10%, n=2) and pneumonia (10%, n=2).
Conclusion: In this small, open-label, unblinded study KE appears effective and safe in treating RSE in adults. Larger, randomized studies will help to confirm data emerging from this preliminary study.
Keywords : Ketamine (KE), refractory status epilepticus (RSE), status epilepticus (SE).