Evidence map›Paper›PMID 38862653›Full record

ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2024

Ketamine reduces seizure and interictal continuum activity in refractory status epilepticus: a multicenter in-person and teleneurocritical care study.

Brittany Harnicher, Nick M Murray, Jena Dresbach, Dave S Collingridge, Breyanna Reachi, Jeremy Bair, Quang Hoang, Gabriel V Fontaine

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Brittany Harnicher *Intermountain Medical Center Department of Pharmacy, 5121 Cottonwood Street, Murray, UT, 84107, USA.
Nick M Murray *Intermountain Medical Center Department of Neurology, Division of Neurocritical Care, 5121 Cottonwood Street, Murray, UT, 84107, USA. nickmmurray@gmail.com.ORCID http://orcid.org/0000-0003-3861-0958
Jena DresbachIntermountain Medical Center Department of Pharmacy, 5121 Cottonwood Street, Murray, UT, 84107, USA.
Dave S CollingridgeIntermountain Medical Center Department of Research Analytics, Murray, UT, USA, 5121 Cottonwood Street, 84107.
Breyanna ReachiIntermountain Medical Center Department of Pharmacy, 5121 Cottonwood Street, Murray, UT, 84107, USA.
Jeremy BairIntermountain Medical Center Department of Pharmacy, 5121 Cottonwood Street, Murray, UT, 84107, USA.
Quang HoangIntermountain Medical Center Department of Pharmacy, 5121 Cottonwood Street, Murray, UT, 84107, USA.
Gabriel V FontaineIntermountain Medical Center Department of Pharmacy, 5121 Cottonwood Street, Murray, UT, 84107, USA.ORCID http://orcid.org/0000-0003-4680-5720

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThere is not a preferred medication for treating refractory status epilepticus (RSE) and intravenous ketamine is increasingly used. Ketamine efficacy, safety, dosage, and influence of other variables on seizure cessation while on ketamine infusions are not well studied. We aimed to characterize ketamine effect on RSE, including interictal activity on electroencephalogram (EEG) and when done by Teleneurocritical care (TNCC).

methodsWe conducted a multicenter, retrospective study from August 2017 to October 2022. Patients 18 years or older who had RSE and received ketamine were included. The primary outcome was effect of ketamine on RSE including interictal activity; secondary outcomes were effect of other variables on RSE, care by TNCC, ketamine infusion dynamics, adverse events, and discharge outcomes. Logistic regression was used.

resultsFifty-one patients from five hospitals met inclusion criteria; 30 patients had RSE and interictal activity on EEG. Median age was 56.8 years (IQR 18.2) and 26% had previously diagnosed epilepsy. Sixteen (31%) patients were treated virtually by TNCC. In those with RSE on EEG, ketamine was added as the fourth antiseizure medication (mean 4.4, SD 1.6). An initial bolus of ketamine was used in 24% of patients (95 mg, IQR 47.5), the median infusion rate was 30.8 mcg/kg/min (IQR 40.4), and median infusion duration was 40 h (IQR 37). Ketamine was associated with 50% cessation of RSE and interictal activity at 24 h in 84% of patients, and complete seizure cessation in 43% of patients. In linear regression, ASMs prior to ketamine were associated with seizure cessation (OR 2.6, 95% CI 0.9-6.9, p = 0.05), while the inverse was seen with propofol infusions (OR 0.02, 95% CI 0.001-0.43, p = 0.01). RSE management by in-person NCC versus virtual by TNCC did not affect rates of seizure cessation.

conclusionsKetamine infusions for RSE were associated with reduced seizure burden at 24 h, with 84% of patients having 50% seizure reduction. Similar efficacy and safety was observed irrespective of underlying RSE etiology or when done via TNCC vs in-person NCC.

Indexed as

ElectroencephalographyKetamineStatus EpilepticusAdultAgedAnticonvulsantsDrug Resistant EpilepsyFemaleHumansMaleMiddle AgedRetrospective StudiesSeizuresAnticonvulsantsKetamineAnticonvulsantsElectroencephalographyEpilepsyHumanKetamineNeurocritical careRefractory status epilepticusSeizureStatus epilepticus

Identifiers

PMID38862653

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.