NMDA Receptor Antagonism in Refractory Status Epilepticus: Right Idea, Wrong Target?

Antagonism of the upregulated NMDA receptors has been a focus of recent literature on refractory status epilepticus (RSE) and superrefractory status epilepticus (SRSE), with ketamine at the forefront. Recent systematic review of ketamine use in SE/RSE displayed 23 articles on the subject, with 110 adult and 52 pediatric patients treated with ketamine for refractory seizures [1]. The review documented a 56·5% and 63·5% seizure response (greater than 50% reduction in electrographic seizures) with ketamine administration in adult and pediatric populations respectively. Complications related to ketamine therapy were sparse. The final recommendations by the authors were an Oxford level 4, GRADE C evidence for the use of ketamine in refractory seizures, with further prospective evaluation recommended [1].