Ketamine for Refractory Status Epilepticus: A Systematic Review

  title={Ketamine for Refractory Status Epilepticus: A Systematic Review},
  author={Anna Rosati and Salvatore De Masi and Renzo Guerrini},
  journal={CNS Drugs},
BackgroundKetamine is an emerging third-line medication for refractory status epilepticus, a medical and neurological emergency requiring prompt and appropriate treatment. Owing to its pharmacological properties, ketamine represents a practical alternative to conventional anaesthetics.ObjectiveThe objective of this study was to assess the efficacy and safety of ketamine to treat refractory status epilepticus in paediatric and adult populations.MethodsWe conducted a literature search using the… 
Efficacy and Safety of Ketamine in Refractory/Super-refractory Nonconvulsive Status Epilepticus: Single-Center Experience
Ketamine appears to be a promising drug in r/srNCSE, and earlier and prolonged infusion, as well as combination with benzodiazepines may increase its efficacy.
The Unease When Using Anesthetics for Treatment-Refractory Status Epilepticus: Still Far Too Many Questions.
  • P. Opic, R. Sutter
  • Medicine, Psychology
    Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
  • 2020
Clinicians should deliberately weigh the advantages and disadvantages of intravenous anesthetic drug therapy in patients with different types of SE usually linked to a favorable outcome (i.e., simple partial, complex partial, or absence seizures).
Efficacy of Home Anticonvulsant Administration for Second-Line Status Epilepticus Treatment
This study provides Class II evidence that for patients with refractory convulsive status epilepticus, use of a home second-line anticonvulsant compared to a non-home anticonVulsant did not significantly affect the probability of stopping seizures.
Management of status epilepticus: a narrative review
An evidence‐based, clinically‐oriented and comprehensive review of status epilepticus and its definitions, aetiologies, treatments, outcomes and prognosis at different stages of the patient’s journey is presented.
Therapeutic Options for Patients with Refractory Status Epilepticus in Palliative Settings or with a Limitation of Life-Sustaining Therapies: A Systematic Review
The evidence for the use of ASDs in RSE beyond that in current guidelines is low, but several effective and well-tolerated options are available that should be considered in this patient population.
Antiepileptic Drug Therapy for Status Epilepticus
Evidence of good quality supports the use of benzodiazepines as the first-line treatment of SE, but evidence informing the administration of second- or third-line treatments is lacking; hence, the recommendations presented herein concerning the treatment of established and refractory SE are based on case series and expert opinions.
Anesthetic Use In Status Epilepticus: A Concise Review
The pharmacology, dosages, major side effects, and clinical use of IV anesthetics in the treatment of SE with an emphasis on the developing literature supporting the use of ketamine for this indication.
Ketamine in seizure management and future pharmacogenomic considerations
It is demonstrated that IV ketamine can be transitioned to oral regimen to shorten length of stay in the intensive care unit and hospital and has future CYP2B6 pharmacogenomic considerations for further dose individualization.
Review and Updates on the Treatment of Refractory and Super Refractory Status Epilepticus
This review focuses on the diagnosis and treatment of RSE and SRSE, which are life-threatening conditions requiring prompt initiation of appropriate treatment to avoid permanent neurological damage and reduce morbidity and mortality.


Super-Refractory Status Epilepticus: A Therapeutic Challenge in Paediatrics.
All three children were aged 6-7 years with prior normal developmental history and no medical illness, and had residual neurological deficits and morbidities like pneumonia and sepsis, which constituted a therapeutic challenge.
(S)-Ketamine in Refractory and Super-Refractory Status Epilepticus: A Retrospective Study
Treatment of SRSE in adult patients with (S)-KET led to resolution of status in 64 %.
Ketamine Continuous Infusion for Refractory Status Epilepticus in a Patient With Anticonvulsant Hypersensitivity Syndrome
A previously healthy 27-year-old woman who presented with prolonged RSE requiring the initiation of multiple AEDs, including high-dose propofol and midazolam continuous infusions is described.
Effectiveness of Electroconvulsive Therapy for Refractory Status Epilepticus in Febrile Infection‐Related Epilepsy Syndrome
A case in which ECT was successfully used for treatment of refractory SE in a pediatric patient with FIRES syndrome is reported, in which conventional antiepileptic drugs fail to control SE in FIRES patients.
Propofol–ketamine combination therapy for effective control of super-refractory status epilepticus