Abstracts

Rationale: Refractory status epilepticus (RSE) is defined as a status epilepticus (SE) not responding to first- and second-line therapies with antiepileptic drugs (AEDs). Ketamine is a noncompetitive NMDA receptor antagonist. Only few cases and retrospective studies about use of Ketamine in SE have been reported. Our aim was to evaluate the efficacy of Ketamine in RSE.Methods: We retrospectively analysed the data of all patients with SE (n=84) who were treated in our neurological intensive care unit from January 2012 (n=70) to February 2013 (n=14). We analysed aetiology, duration and type of SE, daily dose of Ketamine, co-therapeutic agents, treatment response and disposition.Results: In 16 out of 84 patients with SE, Ketamine in combination with Midazolam was used. iIn all 16 episodes, initial treatment with standard AEDs failed. Median age of patients was 68.5 years (range 50-80 years); Causes of RSE: 6/16 post-anoxic, 3/16 systemic infection, 3/16 stroke/intracerebral haemorrhage, 2/16 unknown, 2/16 pre-existing epilepsy with low AED level. Type of RSE: 2/16 myoclonic SE, 4/16 convulsive SE, 10/16 nonconvulsive SE. Median delay of Ketamine initiation 4th day of SE (range 1-18), median maximum dose was 175 mg/hour (range 100-300); RSE was successfully terminated in 10/16 episodes of SE, but 11 out of 16 patients died (3/11 had post-anoxic aetiology).Conclusions: Ketamine may be effective in later stages of SE when adequate first and second line treatment failed, but overall outcome remained poor with a 70% in hospital mortality.