The efficacy and safety of ketamine in refractory and super-refractory status epilepticus: a systemic review

Background: In published animal studies, N-methyl-D-aspartate antagonists such as ketamine (KET) have been reported to reduce Status epilepticus (SE) even after benzodiazepines had failed. In addition, there are studies on the human population that have reported on the use of KET to manage SE seizures. However, despite its history of use as an anesthetic, there are few published review studies on using KET in the treatment of refractory SE (RSE). Objective: This research aims to determine whether KET is an effective treatment for RSE and super-refractory (SRSE) in both children and adult patients. Methods: A systematic search was done on PubMed, EMBASE, Google Scholar, and Cochrane databases from inception until September 12, 2022. In addition, a search was also done for gray literature (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform). Results: The initial search identified 164 articles and only 21 were included in this systematic review; 10 case reports, 9 case series, and 2 cohort studies. In total, the study population is 408. Regarding individual case reports, there were 56 cases, of which 52 were adults. In addition, there were 27 males, 26 females, and 3 unidentified (50). Conclusion: The admission of KET as management for RSE and SRSE has effectively controlled and terminated SE seizures. KET presented to generally be safe, as there are a few reported adverse events. The mortality rates appeared to be high, but none of the studies reported any direct link between these adverse outcomes and using KET to manage SE. [SJEMed 2023; 4(1.000): 060-072]