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This narrative review examines the potential role of ketamine and its enantiomers in the treatment of refractory and super-refractory status epilepticus (RSE and SRSE, respectively). While early studies and a few recent case reports have argued that ketamine has a pro-epileptic profile, recent studies (including one systematic review and meta-analysis) have proposed a promising role for using ketamine/esketamine in the treatment of RSE/SRSE, albeit the current evidence for this role remains of a low quality. There is still no general consensus on when to start ketamine after the seizure onset or what dose the bolus and/or infusion should be. The authors propose a titrating, individualized, and patient-centered approach when considering ketamine/esketamine for treatment-refractory seizures.

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Racemic Ketamine and Esketamine for Treatment of Refractory and Super-Refractory Status Epilepticus

  • 实验方案

  • 发表日期：

    2025年

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  • Mohamed ElSayed,
  • Kaveh Latifi,
  • Lobna Abdelwahab,
  • Marina Ramzy Mourid,
  • Hassan Sayed Kandil,
  • Dania Imtiyaz Khan,
  • Islam Mohammad Shehata

摘要

This narrative review examines the potential role of ketamine and its enantiomers in the treatment of refractory and super-refractory status epilepticus (RSE and SRSE, respectively). While early studies and a few recent case reports have argued that ketamine has a pro-epileptic profile, recent studies (including one systematic review and meta-analysis) have proposed a promising role for using ketamine/esketamine in the treatment of RSE/SRSE, albeit the current evidence for this role remains of a low quality. There is still no general consensus on when to start ketamine after the seizure onset or what dose the bolus and/or infusion should be. The authors propose a titrating, individualized, and patient-centered approach when considering ketamine/esketamine for treatment-refractory seizures.