title: Intravenous ketamine for the treatment of refractory status epilepticus: a retrospective multicenter study.
abstract: OBJECTIVE
  To examine patterns of use, efficacy, and safety of intravenous ketamine for the treatment of refractory status epilepticus (RSE).
  
  
  METHODS
  Multicenter retrospective review of medical records and electroencephalography (EEG) reports in 10 academic medical centers in North America and Europe, including 58 subjects, representing 60 episodes of RSE that were identified between 1999 and 2012. Seven episodes occurred after anoxic brain injury.
  
  
  RESULTS
  Permanent control of RSE was achieved in 57% (34 of 60) of episodes. Ketamine was felt to have contributed to permanent control ("possible" or "likely" responses) in 32% (19 of 60) including seven (12%) in which ketamine was the last drug added (likely responses). Four of the seven likely responses, but none of the 12 possible ones, occurred in patients with postanoxic brain injury. No likely responses were observed when infusion rates were lower than 0.9 mg/kg/h, when ketamine was introduced at least 8 days after SE onset, or after failure of seven or more drugs. Ketamine was discontinued due to possible adverse events in five patients. Complications were mostly attributed to concurrent drugs, especially other anesthetics. Mortality rate was 43% (26 of 60), but was lower when SE was controlled within 24 h of ketamine initiation (16% vs. 56%, p = 0.0047).
  
  
  CONCLUSIONS
  Ketamine appears to be a relatively effective and safe drug for the treatment of RSE. This retrospective series provides preliminary data on effective dose and appropriate time of intervention to aid in the design of a prospective trial to further define the role of ketamine in the treatment of RSE.
authors.affiliation: Comprehensive Epilepsy Center, Department of Neurology, School of Medicine, Yale-New Haven Hospital, Yale University, New Haven, Connecticut 06520, USA. nicolas.gaspard@yale.edu
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gaspard
authors.forename: Brandon
authors.initials: B
authors.lastname: Foreman
authors.forename: Lilith M
authors.initials: LM
authors.lastname: Judd
authors.forename: James N
authors.initials: JN
authors.lastname: Brenton
authors.forename: Barnett R
authors.initials: BR
authors.lastname: Nathan
authors.forename: Blathnaid M
authors.initials: BM
authors.lastname: McCoy
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Otaibi
authors.forename: Ronan
authors.initials: R
authors.lastname: Kilbride
authors.forename: Ivan Sánchez
authors.initials: IS
authors.lastname: Fernández
authors.forename: Lucy
authors.initials: L
authors.lastname: Mendoza
authors.forename: Sophie
authors.initials: S
authors.lastname: Samuel
authors.forename: Asma
authors.initials: A
authors.lastname: Zakaria
authors.forename: Giridhar P
authors.initials: GP
authors.lastname: Kalamangalam
authors.forename: Benjamin
authors.initials: B
authors.lastname: Legros
authors.forename: Jerzy P
authors.initials: JP
authors.lastname: Szaflarski
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
authors.forename: Cecil D
authors.initials: CD
authors.lastname: Hahn
authors.forename: Howard P
authors.initials: HP
authors.lastname: Goodkin
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Hirsch
authors.forename: Suzette M
authors.initials: SM
authors.lastname: Laroche
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011930:Reaction Time / Q000187:drug effects; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D055815:Young Adult
chemical_list: D000700:Analgesics; D007649:Ketamine
keywords: Anesthetics; Antiepileptic drugs; Ketamine; Refractory status epilepticus; Treatment