Transition from intravenous to enteral ketamine for treatment of nonconvulsive status epilepticus

Michael A. Pizzi, Prasuna Kamireddi, William O. Tatum, Jerry J. Shih, Daniel A. Jackson, William D. Freeman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Nonconvulsive status epilepticus (NCSE) is a diagnosis that is often challenging and one that may progress to refractory NCSE. Ketamine is a noncompetitive N-methyl-d-aspartate antagonist that increasingly has been used to treat refractory status epilepticus. Current Neurocritical Care Society guidelines recommend intravenous (IV) ketamine infusion as an alternative treatment for refractory status epilepticus in adults. On the other hand, enteral ketamine use in NCSE has been reported in only 6 cases (1 adult and 5 pediatric) in the literature to date. Case presentation: A 33-year-old woman with a history of poorly controlled epilepsy presented with generalized tonic-clonic seizures, followed by recurrent focal seizures that evolved into NCSE. This immediately recurred within 24 h of a prior episode of NCSE that was treated with IV ketamine. Considering her previous response, she was started again on an IV ketamine infusion, which successfully terminated NCSE. This time, enteral ketamine was gradually introduced while weaning off the IV formulation. Treatment with enteral ketamine was continued for 6 months and then tapered off. There was no recurrence of NCSE or seizures and no adverse events noted during the course of treatment. Conclusion: This case supports the use of enteral ketamine as a potential adjunct to IV ketamine in the treatment of NCSE, especially in cases without coma. Introduction of enteral ketamine may reduce seizure recurrence, duration of stay in ICU, and morbidity associated with intubation.

Original languageEnglish (US)
Article number54
JournalJournal of Intensive Care
Volume5
Issue number1
DOIs
StatePublished - Aug 8 2017

Fingerprint

Status Epilepticus
Ketamine
Small Intestine
Seizures
Therapeutics
Intravenous Infusions
losigame
Recurrence
Coma
Weaning
Intubation
Aspartic Acid
Epilepsy
Guidelines
Pediatrics
Morbidity

Keywords

  • Enteral ketamine
  • Intravenous ketamine
  • Nonconvulsive status epilepticus
  • Refractory status epilepticus
  • Seizures

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Pizzi, M. A., Kamireddi, P., Tatum, W. O., Shih, J. J., Jackson, D. A., & Freeman, W. D. (2017). Transition from intravenous to enteral ketamine for treatment of nonconvulsive status epilepticus. Journal of Intensive Care, 5(1), [54]. https://doi.org/10.1186/s40560-017-0248-6

Transition from intravenous to enteral ketamine for treatment of nonconvulsive status epilepticus. / Pizzi, Michael A.; Kamireddi, Prasuna; Tatum, William O.; Shih, Jerry J.; Jackson, Daniel A.; Freeman, William D.

In: Journal of Intensive Care, Vol. 5, No. 1, 54, 08.08.2017.

Research output: Contribution to journalArticle

Pizzi, Michael A. ; Kamireddi, Prasuna ; Tatum, William O. ; Shih, Jerry J. ; Jackson, Daniel A. ; Freeman, William D. / Transition from intravenous to enteral ketamine for treatment of nonconvulsive status epilepticus. In: Journal of Intensive Care. 2017 ; Vol. 5, No. 1.
@article{1149fa3755af4271ad943bb017946f40,
title = "Transition from intravenous to enteral ketamine for treatment of nonconvulsive status epilepticus",
abstract = "Background: Nonconvulsive status epilepticus (NCSE) is a diagnosis that is often challenging and one that may progress to refractory NCSE. Ketamine is a noncompetitive N-methyl-d-aspartate antagonist that increasingly has been used to treat refractory status epilepticus. Current Neurocritical Care Society guidelines recommend intravenous (IV) ketamine infusion as an alternative treatment for refractory status epilepticus in adults. On the other hand, enteral ketamine use in NCSE has been reported in only 6 cases (1 adult and 5 pediatric) in the literature to date. Case presentation: A 33-year-old woman with a history of poorly controlled epilepsy presented with generalized tonic-clonic seizures, followed by recurrent focal seizures that evolved into NCSE. This immediately recurred within 24 h of a prior episode of NCSE that was treated with IV ketamine. Considering her previous response, she was started again on an IV ketamine infusion, which successfully terminated NCSE. This time, enteral ketamine was gradually introduced while weaning off the IV formulation. Treatment with enteral ketamine was continued for 6 months and then tapered off. There was no recurrence of NCSE or seizures and no adverse events noted during the course of treatment. Conclusion: This case supports the use of enteral ketamine as a potential adjunct to IV ketamine in the treatment of NCSE, especially in cases without coma. Introduction of enteral ketamine may reduce seizure recurrence, duration of stay in ICU, and morbidity associated with intubation.",
keywords = "Enteral ketamine, Intravenous ketamine, Nonconvulsive status epilepticus, Refractory status epilepticus, Seizures",
author = "Pizzi, {Michael A.} and Prasuna Kamireddi and Tatum, {William O.} and Shih, {Jerry J.} and Jackson, {Daniel A.} and Freeman, {William D.}",
year = "2017",
month = "8",
day = "8",
doi = "10.1186/s40560-017-0248-6",
language = "English (US)",
volume = "5",
journal = "Journal of Intensive Care",
issn = "2052-0492",
publisher = "Springer International Publishing AG",
number = "1",

}

TY - JOUR

T1 - Transition from intravenous to enteral ketamine for treatment of nonconvulsive status epilepticus

AU - Pizzi, Michael A.

AU - Kamireddi, Prasuna

AU - Tatum, William O.

AU - Shih, Jerry J.

AU - Jackson, Daniel A.

AU - Freeman, William D.

PY - 2017/8/8

Y1 - 2017/8/8

N2 - Background: Nonconvulsive status epilepticus (NCSE) is a diagnosis that is often challenging and one that may progress to refractory NCSE. Ketamine is a noncompetitive N-methyl-d-aspartate antagonist that increasingly has been used to treat refractory status epilepticus. Current Neurocritical Care Society guidelines recommend intravenous (IV) ketamine infusion as an alternative treatment for refractory status epilepticus in adults. On the other hand, enteral ketamine use in NCSE has been reported in only 6 cases (1 adult and 5 pediatric) in the literature to date. Case presentation: A 33-year-old woman with a history of poorly controlled epilepsy presented with generalized tonic-clonic seizures, followed by recurrent focal seizures that evolved into NCSE. This immediately recurred within 24 h of a prior episode of NCSE that was treated with IV ketamine. Considering her previous response, she was started again on an IV ketamine infusion, which successfully terminated NCSE. This time, enteral ketamine was gradually introduced while weaning off the IV formulation. Treatment with enteral ketamine was continued for 6 months and then tapered off. There was no recurrence of NCSE or seizures and no adverse events noted during the course of treatment. Conclusion: This case supports the use of enteral ketamine as a potential adjunct to IV ketamine in the treatment of NCSE, especially in cases without coma. Introduction of enteral ketamine may reduce seizure recurrence, duration of stay in ICU, and morbidity associated with intubation.

AB - Background: Nonconvulsive status epilepticus (NCSE) is a diagnosis that is often challenging and one that may progress to refractory NCSE. Ketamine is a noncompetitive N-methyl-d-aspartate antagonist that increasingly has been used to treat refractory status epilepticus. Current Neurocritical Care Society guidelines recommend intravenous (IV) ketamine infusion as an alternative treatment for refractory status epilepticus in adults. On the other hand, enteral ketamine use in NCSE has been reported in only 6 cases (1 adult and 5 pediatric) in the literature to date. Case presentation: A 33-year-old woman with a history of poorly controlled epilepsy presented with generalized tonic-clonic seizures, followed by recurrent focal seizures that evolved into NCSE. This immediately recurred within 24 h of a prior episode of NCSE that was treated with IV ketamine. Considering her previous response, she was started again on an IV ketamine infusion, which successfully terminated NCSE. This time, enteral ketamine was gradually introduced while weaning off the IV formulation. Treatment with enteral ketamine was continued for 6 months and then tapered off. There was no recurrence of NCSE or seizures and no adverse events noted during the course of treatment. Conclusion: This case supports the use of enteral ketamine as a potential adjunct to IV ketamine in the treatment of NCSE, especially in cases without coma. Introduction of enteral ketamine may reduce seizure recurrence, duration of stay in ICU, and morbidity associated with intubation.

KW - Enteral ketamine

KW - Intravenous ketamine

KW - Nonconvulsive status epilepticus

KW - Refractory status epilepticus

KW - Seizures

UR - http://www.scopus.com/inward/record.url?scp=85027164546&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85027164546&partnerID=8YFLogxK

U2 - 10.1186/s40560-017-0248-6

DO - 10.1186/s40560-017-0248-6

M3 - Article

AN - SCOPUS:85027164546

VL - 5

JO - Journal of Intensive Care

JF - Journal of Intensive Care

SN - 2052-0492

IS - 1

M1 - 54

ER -