title: (S)-Ketamine in Refractory and Super-Refractory Status Epilepticus: A Retrospective Study.
abstract: The aim was to describe the safety and efficacy of (S)-ketamine [(S)-KET] in a series of patients with refractory and super-refractory status epilepticus (RSE and SRSE) in a specialized neurological intensive care unit (NICU).
  
  
  
  We retrospectively analyzed the data of patients with RSE and SRSE treated with (S)-KET in the NICU, Salzburg, Austria, from 2011 to 2015. Data collection included demographic features, clinical presentation, diagnosis, electroencephalogram (EEG) data, anticonvulsant treatment, timing, and duration of treatment with (S)-KET. Outcomes were seizure control and death.
  
  
  
  A total of 42 patients (14 women) with RSE and SRSE were treated with (S)-KET. The median duration of status epilepticus (SE) was 10 days [first quartile (Q1) 5.0, Q3 21.0]; the median latency from SE onset to the first administration of (S)-KET was 3 days (Q1 2.0, Q3 6.8). Prior to (S)-KET administration, patients had received a median of two (Q1 2.0, Q3 3.0) anesthetics and three (Q1 2.0, Q3 4.0) antiepileptic drugs. Forty percent of patients (17/42) received propofol: 65 % prior to (S)-KET; 35 % at the same time with (S)-KET. Seven patients received a median bolus of (S)-KET of 200 mg (Q1 200, Q3 250) followed by a continuous infusion, while 35 started with a continuous infusion (maximum rate median 2.55 mg/kg/h; Q1 2.09, Q3 3.22). In 64 % of patients (27/42), (S)-KET was the last drug before SE cessation; in five patients, it was given with propofol at the same time. Median duration of administration was 4 days (Q1 2.0, Q3 6.8). Overall (S)-KET treatment was well tolerated, adverse effects were not observed, and overall mortality was 45.2 %.
  
  
  
  Treatment of SRSE in adult patients with (S)-KET led to resolution of status in 64 %. No adverse events were found, indicating a favorable safety profile.
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.|Centre for Cognitive Neuroscience, Salzburg, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Höfler
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.|Centre for Cognitive Neuroscience, Salzburg, Austria.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Rohracher
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.|Centre for Cognitive Neuroscience, Salzburg, Austria.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Kalss
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.|Centre for Cognitive Neuroscience, Salzburg, Austria.|Department of Mathematics, Paris Lodron University, Salzburg, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Zimmermann
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.|Centre for Cognitive Neuroscience, Salzburg, Austria.
authors.forename: Judith
authors.initials: J
authors.lastname: Dobesberger
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.|Centre for Cognitive Neuroscience, Salzburg, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Pilz
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.|Centre for Cognitive Neuroscience, Salzburg, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Leitinger
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.|Centre for Cognitive Neuroscience, Salzburg, Austria.|Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Giorgi
authors.initials: G
authors.lastname: Kuchukhidze
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.|Centre for Cognitive Neuroscience, Salzburg, Austria.|Department of Psychology, Paris Lodron University, Salzburg, Austria.
authors.forename: Kevin
authors.initials: K
authors.lastname: Butz
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.|Centre for Cognitive Neuroscience, Salzburg, Austria.|Department of Psychology, Paris Lodron University, Salzburg, Austria.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Taylor
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria.|Centre for Cognitive Neuroscience, Salzburg, Austria.
authors.forename: Helmut
authors.initials: H
authors.lastname: Novak
authors.affiliation: Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University of Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria. e.trinka@salk.at.|Centre for Cognitive Neuroscience, Salzburg, Austria. e.trinka@salk.at.
authors.forename: Eugen
authors.identifier: 0000-0002-5950-2692
authors.initials: E
authors.lastname: Trinka
mesh_terms: D000368:Aged; D000777:Anesthetics / Q000008:administration & dosage; D000927:Anticonvulsants / Q000008:administration & dosage; D000069279:Drug Resistant Epilepsy / Q000188:drug therapy*; D004569:Electroencephalography; D018691:Excitatory Amino Acid Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics; D000927:Anticonvulsants; D018691:Excitatory Amino Acid Antagonists; D007649:Ketamine; D015742:Propofol