4.7 Article

Ketamine for Management of Neonatal and Pediatric Refractory Status Epilepticus

Journal

NEUROLOGY
Volume 99, Issue 12, Pages E1227-E1238

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0000000000200889

Keywords

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Funding

  1. National Institute for Neurological Disorders and Stroke [K02 NS112600, U54 NS108874]
  2. Eunice Kennedy Shriver National Institute of Child Health and Human Development
  3. University of Pennsylvania [U54 HD086984]
  4. Children's Hospital of Philadelphia through the Epilepsy NeuroGenetics Initiative (ENGIN)
  5. National Center for Advancing Translational Sciences of the NIH [UL1TR001878]
  6. Institute for Translational Medicine and Therapeutics (ITMAT) Transdisciplinary Program in Translational Medicine and Therapeutics at the Perelman School of Medicine of the University of Pennsylvania

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This retrospective study analyzed the use of ketamine infusion for refractory status epilepticus (RSE) in pediatric patients. The results showed that ketamine was effective in reducing seizure frequency and had few adverse events.
Background and Objectives Few data are available regarding the use of anesthetic infusions for refractory status epilepticus (RSE) in children and neonates, and ketamine use is increasing despite limited data. We aimed to describe the impact of ketamine for RSE in children and neonates. Methods Retrospective single-center cohort study of consecutive patients admitted to the intensive care units of a quaternary care children's hospital treated with ketamine infusion for RSE. Results Sixty-nine patients were treated with a ketamine infusion for RSE. The median age at onset of RSE was 0.7 years (interquartile range 0.15-7.2), and the cohort included 13 (19%) neonates. Three patients (4%) had adverse events requiring intervention during or within 12 hours of ketamine administration, including hypertension in 2 patients and delirium in 1 patient. Ketamine infusion was followed by seizure termination in 32 patients (46%), seizure reduction in 19 patients (28%), and no change in 18 patients (26%). Discussion Ketamine administration was associated with few adverse events, and seizures often terminated or improved after ketamine administration. Further data are needed comparing first-line and subsequent anesthetic medications for treatment of pediatric and neonatal RSE. Classification of Evidence This study provides Class IV evidence on the therapeutic utility of ketamine for treatment of RSE in children and neonates.

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