Ketamine in seizure management and future pharmacogenomic considerations

Ketamine is a noncompetitive N-methyl-_D-aspartate antagonist with emergingevidence for use in medically refractory epilepsy. We describe the novel use oflow-dose intravenous (IV) ketamine transitioning to enteral formulation in a patientwith drug-resistant localization-related refractory epilepsy. We performed aNational Library of Medicine (NLM) literature review using search terms “ketamine”,“low dose”, and “seizure” for similar cases, followed by an illustrative clinicalcase. Our NLM search engine methodology yielded 24 hits, none of which described useof low-dose ketamine for seizures. Anesthetic doses are used for status epilepticus,but we show that in a patient with postoperative worsening of his chronic seizureburden, low-dose IV ketamine can be used to avoid oversedation and intubation. Wedemonstrate that IV ketamine can be transitioned to oral regimen to shorten lengthof stay in the intensive care unit and hospital and has future CYP2B6pharmacogenomic considerations for further dose individualization.