title: Treatment of status epilepticus with ketamine, are we there yet?
abstract: Status epilepticus (SE), a neurological emergency both in adults and in children, could lead to brain damage and even death if untreated. Generalized convulsive SE (GCSE) is the most common and severe form, an example of which is that induced by organophosphorus nerve agents. First- and second-line pharmacotherapies are relatively consensual, but if seizures are still not controlled, there is currently no definitive data to guide the optimal choice of therapy. The medical community seems largely reluctant to use ketamine, a noncompetitive antagonist of the N-methyl-d-aspartate glutamate receptor. However, a review of the literature clearly shows that ketamine possesses, in preclinical studies, antiepileptic properties and provides neuroprotection. Clinical evidences are scarcer and more difficult to analyze, owing to a use in situations of polytherapy. In absence of existing or planned randomized clinical trials, the medical community should make up its mind from well-conducted preclinical studies performed on appropriate models. Although potentially active, ketamine has no real place for the treatment of isolated seizures, better accepted drugs being used. Its best usage should be during GCSE, but not waiting for SE to become totally refractory. Concerns about possible developmental neurotoxicity might limit its pediatric use for refractory SE.
authors.affiliation: Département de Toxicologie et risques chimiques, Institut de Recherche Biomédicale des Armées - Centre de Recherches du Service de Santé des Armées (IRBA-CRSSA), La Tronche Cedex, France. fdorandeu@crssa.net
authors.forename: Frederic
authors.initials: F
authors.lastname: Dorandeu
authors.forename: Franck
authors.initials: F
authors.lastname: Dhote
authors.forename: Laure
authors.initials: L
authors.lastname: Barbier
authors.forename: Benjamin
authors.initials: B
authors.lastname: Baccus
authors.forename: Guy
authors.initials: G
authors.lastname: Testylier
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D000818:Animals; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D011042:Poisons / Q000633:toxicity; D016194:Receptors, N-Methyl-D-Aspartate / Q000378:metabolism; D013226:Status Epilepticus / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000700:Analgesics; D011042:Poisons; D016194:Receptors, N-Methyl-D-Aspartate; D007649:Ketamine