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Double antiglutamatergic treatment in patients with status epilepticus: A case series

Published:November 11, 2022DOI:https://doi.org/10.1016/j.yebeh.2022.108954

      Highlights

      • Status epilepticus is a neurological emergency that requires timely administration of appropriate medications.
      • Ketamine effect of noncompetitive NMDA receptor antagonism was augmented by co-administering perampanel acting at AMPA receptors.
      • Data is limited on the use of perampanel in humans.
      • This combination could provide if validated, a novel approach to treating status epilepticus.

      Abstract

      Introduction

      Status epilepticus (SE) continues to be a challenging neurological emergency with high morbidity and mortality. During treatment, different regimens are practiced encompassing all known seizure termination mechanisms. To our knowledge, this is the first case series report describing EEG patterns and clinical outcomes in patients treated with ketamine and perampanel (PER) concomitantly.

      Objective

      To assess clinical and electrographic outcomes in patients receiving dual antiglutamatergic therapy in SE.

      Results

      Twenty-one out of twenty five patients were treated with ketamine, and four patients with ketamine were associated with PER. In the ketamine plus PER group, three out of four patients had convulsive SE, and one had non-convulsive status epilepticus (NCSE), whereas eight patients in the ketamine group had NCSE. The incidence of beta pattern appearance on EEG after starting patients on ketamine and PER was achieved in all four patients (100%) compared to (61.9%) in the other group. A burst suppression pattern was recorded in 75% of patients treated with ketamine and PER, in comparison to 28.5% of patients in patients treated with a different regimen. The time to resolution of SE was significantly shorter in the ketamine group (median 24 (24–64) h vs. 6 (05–144) h p > 0.05). Moreover, the average number of days on IV anesthetic was slightly lower in a patient treated with PER concomitantly. In terms of morbidity, the average increase in mRS was also lower in the ketamine and PER group, although it was not statistically significant.

      Conclusions

      Dual anti-glutamatergic therapy could provide a favorable approach to treating SE, which yet needs to be further investigated through larger randomized control studies.

      Keywords

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