Ketamine in Status Epilepticus

Q: Ketamine works better in which phase of status epilepticus? (select one)

A) Early
B) Later


Answer:  Later

Ketamine is a good choice if there is no response to benzodiazepines or barbiturates in status epilepticus. Ketamine is more effective in later phase of status epilepticus. 

Ketamine is an N-methyl-D-aspartase (NMDA) antagonist. It works better when gamma-aminobutyric (GABA) agonists or promoters (eg, benzodiazepines and barbiturates) have lost some effectiveness.


References:

1. Sheth RD, Gidal BE. Refractory status epilepticus: response to ketamine. Neurology 1998; 51:1765. 

2. Gaspard N, Foreman B, Judd LM, et al. Intravenous ketamine for the treatment of refractory status epilepticus: a retrospective multicenter study. Epilepsia 2013; 54:1498. 

3. Basha MM, Alqallaf A, Shah AK. Drug-induced EEG pattern predicts effectiveness of ketamine in treating refractory status epilepticus. Epilepsia 2015; 56:e44. 

 4. Mazarati AM, Wasterlain CG. N-methyl-D-asparate receptor antagonists abolish the maintenance phase of self-sustaining status epilepticus in rat. Neurosci Lett 1999; 265:187.