Ketamine successfully terminates malignant status epilepticus.
A 22-year-old woman with mitochondriopathy and pre-existing epilepsy developed status epilepticus (SE) not responding to benzodiazepines, phenytoin, thiopental, and propofol. SE was terminated within days after supplemental administration of continuous ketamine infusion to midazolam. The case suggests strong anticonvulsant properties of ketamine even after failure of GABAergic anesthetics, likely due to increased NMDA receptor expression with ongoing seizure activity. Thus, ketamine should be incorporated into therapeutic regimens for difficult-to-treat SE.
Prüss
Harald
H
Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Holtkamp
Martin
M
D000768:Anesthesia, General; D000778:Anesthetics, Dissociative / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D003128:Coma / Q000209:etiology; D000074002:DNA Polymerase gamma; D004259:DNA-Directed DNA Polymerase / Q000235:genetics; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination; D004569:Electroencephalography / Q000187:drug effects; D020938:Epilepsy, Partial, Motor / Q000188:drug therapy / Q000209:etiology; D004830:Epilepsy, Tonic-Clonic / Q000188:drug therapy / Q000209:etiology; D018691:Excitatory Amino Acid Antagonists / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007649:Ketamine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use; D017237:Mitochondrial Encephalomyopathies / Q000150:complications* / Q000235:genetics; D011782:Quadriplegia / Q000209:etiology; D012008:Recurrence; D013226:Status Epilepticus / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
D000778:Anesthetics, Dissociative; D000927:Anticonvulsants; D018691:Excitatory Amino Acid Antagonists; D007649:Ketamine; D000074002:DNA Polymerase gamma; D004259:DNA-Directed DNA Polymerase; C413027:POLG protein, human; D008874:Midazolam