Ketamine for refractory status epilepticus: a case of possible ketamine-induced neurotoxicity.
A 44-year-old man with treated neurosyphilis presented with subclinical status epilepticus (SE) refractory to intravenous high-dose lorazepam, phenytoin, and valproic acid over 4 days. Ketamine infusion was instituted after low-dose propofol sedation with gradual control of electrographic seizures over 72h. Reevaluation 3 months later revealed diffuse cerebellar and worsened cerebral atrophy, consistent with animal models of N-methyl-D-aspartate antagonist-mediated neurotoxicity. Animal studies of prolonged ketamine therapy are required before widespread human use in SE.
Ubogu
Eroboghene E
EE
Department of Neurology, University Hospitals of Cleveland, Hanna House 5th Floor, 11100 Euclid Avenue, Cleveland, OH 44106-5040, USA.
Sagar
Stephen M
SM
Lerner
Alan J
AJ
Maddux
Brian N
BN
Suarez
José I
JI
Werz
Mary Ann
MA
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000473:pathology; D004569:Electroencephalography; D018691:Excitatory Amino Acid Antagonists / Q000009:adverse effects*; D006801:Humans; D007649:Ketamine / Q000009:adverse effects*; D008140:Lorazepam / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D020258:Neurotoxicity Syndromes / Q000209:etiology*; D010672:Phenytoin / Q000627:therapeutic use; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors; D012720:Severity of Illness Index; D013226:Status Epilepticus / Q000175:diagnosis / Q000188:drug therapy*; D014635:Valproic Acid / Q000627:therapeutic use
D000927:Anticonvulsants; D018691:Excitatory Amino Acid Antagonists; D016194:Receptors, N-Methyl-D-Aspartate; D014635:Valproic Acid; D010672:Phenytoin; D007649:Ketamine; D008140:Lorazepam