Ketamine use in the refractory and super refractory status epilepticus: a systematic review

Refractory and super-refractory status epilepticus are severe conditions associated with high morbidity and mortality. A systematic review analyzed 12 studies comprising 491 patients who received ketamine as part of multimodal therapy after failure of other antiseizure medications and intravenous anesthetics. Ketamine doses ranged from 0.05 to 10.5 mg/kg/h and treatment duration ranged from 6 hours to 29 days. Response rates ranged from 43.3% for complete seizure cessation to 100% for overall improvement. Short-term or hospital survival ranged from 45.8% to 81.8%. Ketamine was not associated with significant acute hemodynamic problems. However, the independent effect of ketamine on sustained seizure control and functional recovery remains uncertain.