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Abstract

Introduction: Treatment of Refractory Status Epilepticus (RSE), which is defined as status epilepticus that is resistant to initial standard antiepileptic treatment, requires intravenous anesthetic agents. In addition to propofol, benzodiazepines and barbiturates, the use of ketamine administration for RSE has been reported in isolated cases and collectively in multi-center series. Methods: A retrospective chart review of 14 patients admitted to the Neurological ICU for management of RSE between 2010 and 2012 at Ochsner Medical Center. Results: RSE in 14 patients with ages ranging from 26–89 years (8 Females and 4 Males) were treated with a combination of propofol and ketamine infusions after failure of initial conventional therapy. Propofol infusion rates varied from 10 – 183 micrograms/ kg per/minute; the duration varied from 4–41 days. Ketamine infusion rates varied from 15–100 mcg/kg/min; the duration varied from 3 – 28 days. The duration of combination therapy varied from 1–26 days. Decrease in blood pressure requiring the use of vasopressors was observed in 4/14 (28%) of the cases and anti-hypertensive infusion was required in one 1(7%) case. The resolution of RSE was achieved in 11/14(78%) of the patients. The mortality rate our group was 4/14(35%). The mortality did not result from of complications of the anti-epileptic management. In 4/14 (35%) patients care was family’s request to withdraw care based on patient’s wishes and severity of underlying neurological injury. Conclusions: Successful control of RSE was obtained in all patients who completed this course of therapy. The combination of propofol and ketamine infusion did lead to some hemodynamic changes that were easily managed with vasoactive agents. These findings suggest that this regiment can be a therapeutic modality in treatment of refractory status epilepticus.