Enteral Ketamine for Status Epilepticus in Children with Epilepsy

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY Pediatric neurology Pub Date : 2024-05-10 DOI:10.1016/j.pediatrneurol.2024.05.006

Laura DiDomenico MD, MS (Trainee Author) , Lisa C. Garrity SM, PharmD, BCPS , Kelsey E. Poisson MD , Eileen Broomall MD (Senior Author)

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Abstract

Background

Approximately 10% to 20% of children with epilepsy experience status epilepticus (SE), and children with seizure clustering are at higher risk. Ketamine is growing in use for SE. This study examines the efficacy and safety of enteral ketamine in the treatment of convulsive status epilepticus (CSE) characterized by refractory seizure clusters and nonconvulsive status epilepticus (NCSE) in children with epilepsy.

Methods

Patient charts were reviewed retrospectively. Children with epilepsy aged one to 21 years presenting in SE and treated with enteral ketamine between September 1, 2021 and September 1, 2022 at a pediatric tertiary care center were identified. Resolution or reduction in seizure frequency within 48 hours, clinical presentation, endotracheal intubation, hospitalization duration, side effects, and readmission were assessed.

Results

Nine patients aged two to 21 years were identified. Six patients presented in CSE characterized by recurrent seizures, and three patients presented in NCSE. Five patients had genetic epilepsies, including PCDH19- and MECP2-related epilepsy. Seven patients had resolution or reduction in seizures within 48 hours of ketamine initiation. Two patients were intubated. Hospitalization duration ranged from one to 34 days. Three patients reported side effects. Three patient readmissions with early ketamine treatment had equal or shorter hospitalizations.

Conclusions

Enteral ketamine may prove an effective, well-tolerated option for treatment of convulsive and nonconvulsive SE in children with epilepsy, including genetic epilepsies, and may prevent intubation and shorten hospitalization time.

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肠内氯胺酮治疗癫痫儿童的癫痫状态

背景大约10%到20%的癫痫患儿会出现癫痫状态（SE），而有癫痫发作聚集现象的患儿风险更高。氯胺酮越来越多地被用于治疗癫痫状态。本研究探讨了肠内氯胺酮治疗以难治性发作群为特征的惊厥性癫痫状态（CSE）和非惊厥性癫痫状态（NCSE）的有效性和安全性。确定了 2021 年 9 月 1 日至 2022 年 9 月 1 日期间在一家儿科三级护理中心接受氯胺酮肠内治疗的 1 至 21 岁 SE 型癫痫患儿。对 48 小时内癫痫发作频率的缓解或减少、临床表现、气管插管、住院时间、副作用和再入院情况进行了评估。六名患者表现为以反复发作为特征的CSE，三名患者表现为NCSE。五名患者患有遗传性癫痫，包括 PCDH19 和 MECP2 相关癫痫。七名患者在使用氯胺酮 48 小时内癫痫发作得到缓解或减少。两名患者接受了插管治疗。住院时间从 1 天到 34 天不等。三名患者报告了副作用。结论肠内氯胺酮可能被证明是治疗癫痫（包括遗传性癫痫）患儿惊厥性和非惊厥性 SE 的一种有效、耐受性良好的选择，并可避免插管和缩短住院时间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric neurology 医学-临床神经学

CiteScore

4.80

自引率

2.60%

发文量

176

审稿时长

78 days

期刊介绍： Pediatric Neurology publishes timely peer-reviewed clinical and research articles covering all aspects of the developing nervous system. Pediatric Neurology features up-to-the-minute publication of the latest advances in the diagnosis, management, and treatment of pediatric neurologic disorders. The journal''s editor, E. Steve Roach, in conjunction with the team of Associate Editors, heads an internationally recognized editorial board, ensuring the most authoritative and extensive coverage of the field. Among the topics covered are: epilepsy, mitochondrial diseases, congenital malformations, chromosomopathies, peripheral neuropathies, perinatal and childhood stroke, cerebral palsy, as well as other diseases affecting the developing nervous system.