Ketamine effective treatment for neonatal, pediatric epilepsy

Treatment with ketamine significantly improved seizure occurrence related to refractory status epilepticus in both neonates and children, according to results of a study published in Neurology.

“Many children with status epilepticus have persistent seizures despite administration of at least two appropriately dosed antiseizure medications,” Marin Jacobwitz, CRNP, of the department of pediatrics, Children’s Hospital of Philadelphia, and colleagues wrote. “Ketamine, a noncompetitive N-methyl-D-aspartate glutamate receptor antagonist, may be a beneficial alternative anesthetic.”

Researchers sought to determine the safety and efficacy of ketamine as a therapeutic for refractory status epilepticus (RSE) in children and neonates.

The retrospective single-center cohort study included 69 patients (median age at RSE onset 0.7 years, 13 were neonates 0 to 30 days old) admitted to the neonatal, cardiac or pediatric ICUs of Children’s Hospital of Philadelphia and subsequently treated with ketamine infusion for RSE. All patients underwent continuous EEG monitoring during ketamine administration. Seizure burden was classified as acute repetitive (< 5 minutes) or status epilepticus (SE; > 5 minutes of continuous and/or electrographic seizure activity or recurrent seizure activity without recovery between seizures). SE was subsequently subcategorized as brief seizures totaling less than 5 minutes per hour, seizures greater than 5 minutes or both. RSE subtypes were also classified.

Results showed that ketamine infusion was followed by seizure termination in 32 patients, seizure reduction in 19 patients and no change in 18 patients. Data also revealed three patients had adverse events requiring intervention during or within 12 hours of ketamine administration, including hypertension in two patients and delirium in one patient.

“These data suggest ketamine may be a beneficial anesthetic infusion for neonates and children with SE,” Jacobwitz and colleagues wrote.