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Review
. 2024 Mar-Apr;47(2):37-43.
doi: 10.1097/WNF.0000000000000582. Epub 2024 Feb 1.

Provider Experience With the Use of Ketamine for Refractory Status Epilepticus

Gabriela Tantillo  1 , Nicole Davis  2 , Justin Granstein  3 , Ji Yeoun Yoo  4 , Parul Agarwal, Kaitlin Reilly  5 , Alexandra Reynolds, Gina Kayal  1 , John Liang, Nathalie Jetté
Affiliations
Review

Provider Experience With the Use of Ketamine for Refractory Status Epilepticus

Gabriela Tantillo et al. Clin Neuropharmacol. 2024 Mar-Apr.

Abstract

Objective: Refractory status epilepticus (RSE) treated with anesthetic agents can be associated with complications including respiratory depression and hypotension. Ketamine is an emerging RSE treatment, but optimal dosing and timing are unknown. We studied provider attitudes and practices regarding the use of ketamine for RSE.

Methods: A literature review informed the creation of the survey, developed by professionals in epilepsy, pharmacy, and neurocritical care. The survey was distributed to members of the Critical Care EEG Monitoring and Research Consortium, Neurocritical Care Society, American Academy of Neurology Synapse community, American Epilepsy Society, and the Canadian League Against Epilepsy. Descriptive statistics were calculated.

Results: There were 109 respondents. First-line agents for RSE were midazolam (53%), propofol (42%), pentobarbital (2%), and ketamine (1%). Reasons for ketamine use included failure of midazolam/propofol to control seizures (81%) or hypotension on another anesthetic (35%). Perceived contraindications included hypertension (37%), elevated intracranial pressure (24%), and heart failure (18%). Perceived benefits included decreased use of vasopressors (53%) and more rapid RSE control when used adjunctively (49%). Routine ketamine users often treated more than 10 RSE cases per year, worked as intensivists or at academic institutions. Of the respondents, 59% found ketamine useful for RSE and 94% were interested in learning more about its use.

Conclusions: Although most participants found ketamine helpful for RSE, it is mainly used as a second-line agent adjunctively with midazolam or propofol. Perceived ketamine benefits included decreased need for hemodynamic support and more rapid seizure control when used in conjunction with other anesthetics. Perceived contraindications centered on cardiac and intracranial pressure concerns.

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Conflict of interest statement

Conflicts of interest: N.D., J.G., P.A., K.R., A.R., J.L., and G.K. have no disclosures relevant to this manuscript. G.T. will receive an honorarium for her work as a faculty speaker at the American Epilepsy Society. J.Y.Y. serves as a consultant for Zimmer Biomet and receives royalty from Elsevier for the book, Primer of EEG. N.J. received grant funding paid to her institution for grants unrelated to this work from NINDS (NIH U24NS107201, NIH IU54NS100064). She also receives an honorarium for her work as an Associate Editor of Epilepsia.

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