Dual antiglutamatergic treatment in patients with status epilepticus: a case series (P9-1.008)

Abstract

<h3>Objective:</h3> To assess clinical and electrographic outcomes in patients receiving dual anti-glutamatergic therapy in status epilepticus. <h3>Background:</h3> Status epilepticus continues to be a challenging neurological emergency with high morbidity and mortality. To our knowledge, this is the first case series describing EEG patterns and clinical outcomes in patients treated with Ketamine and Perampanel concomitantly. <h3>Design/Methods:</h3> Retrospectively analyzed records of 25 patients treated with IV Ketamine for Status Epilepticus (SE), Refractory SE (RSE), and Super RSE (SRSE) between January 2019 and January 2022. RSE and SRSE are defined per the new classification/nomenclature. The following parameters were analyzed: Modified Rankin Scale (mRS) at admission and discharge, days on IV ketamine, time to resolution of status epilepticus, presence, or absence of burst suppression after initiating treatment and presence of beta pattern and its sustainability on EEG after treatment. We compared these parameters in patients who received Perampanel concomitantly with Ketamine to those who didn’t. <h3>Results:</h3> 21 out of 25 patients were treated with ketamine and other agents, and 4 patients with Ketamine and Perampanel. The incidence of beta pattern appearance on EEG after starting patients on Ketamine and Perampanel was achieved in all 4 patients (100%) in comparison to (61.9%) in Ketamine-only group. Burst suppression pattern was recorded in 75% of patients treated with Ketamine and Perampanel compared to 28.5% in the other. The time to resolution of status epilepticus was significantly shorter in Ketamine-only group. The average number of days on IV anesthetic was slightly lower in patient treated with concomitant Perampanel. The average increase in mRS was also lower in the group of interest. <h3>Conclusions:</h3> Dual anti-glutamatergic therapy could provide a favorable approach to treating status epilepticus, which yet needs to be further investigated through larger randomized control studies. <b>Disclosure:</b> Dr. Souidan has nothing to disclose. Prof. ANDRADE MACHADO has nothing to disclose. Dr. Lagnf has nothing to disclose. Dr. Pokharel has nothing to disclose. Dr. Elsayed has nothing to disclose.