Ketamine Therapy in the Management of Refractory Seizures in an Extremely Premature Neonate: a Case Report
Abstract number :
2.248
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2024
Submission ID :
1248
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Vanessa Mbanga, MD – Baylor College of Medicine
Himanshu Kaulas, MD – Saint Louis University
Leenah Abugisisa, MD – Saint Louis University
Glen Fenton, MD – Saint Louis University
Rationale: Neonatal seizures, particularly refractory status epilepticus (RSE), present significant challenges in neonatal intensive care units (NICUs), especially among extremely premature infants. There is further complexity added to the management of this patient population due to underlying brain immaturity and susceptibility to complications. Ketamine, a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, has emerged as a potential adjunctive therapy for RSE in pediatric and adult populations.
Methods: We present a case of refractory status epilepticus in a baby born at 25 weeks gestational age, with a course complicated by multiple comorbidities, including bilateral germinal matrix hemorrhages, E. Coli ventriculitis, and hyaline membrane disease. Initial management involving Phenobarbital, Levetiracetam, and Fosphenytoin was ineffective. Hence, a Midazolam infusion was started. With each bolus of Midazolam, the seizures initially responded favorably, but then there was a notable paradoxical worsening of seizures. These were more prolonged and, at times, occurred in clusters back to back; they were all electrographic and better defined by continuous video electroencephalography. The decision was made then to start Ketamine infusion.
Results: Despite conventional antiepileptic therapies, including Phenobarbital, Levetiracetam, Fosphenytoin, and Midazolam, the patient's seizures remained uncontrolled until Ketamine infusion was initiated. Ketamine led to significant suppression of seizure activity, allowing for its successful discontinuation without recurrence of seizures.
Conclusions: This case highlights the potential of ketamine as an adjunctive therapy in managing refractory status epilepticus in extremely premature neonates. Further research is warranted to elucidate the optimal dosing and safety profile of Ketamine in this vulnerable population.
Funding: None
Clinical Epilepsy