Efficacy and safety of ketamine for neonatal refractory status epilepticus: case report and systematic review.
antiseizure medication response
ketamine
neonatal seizure treatment
neonatal status epilepticus
refractory status epilepctius (RSE)
Journal
Frontiers in pediatrics
ISSN: 2296-2360
Titre abrégé: Front Pediatr
Pays: Switzerland
ID NLM: 101615492
Informations de publication
Date de publication:
2023
2023
Historique:
received:
19
03
2023
accepted:
23
05
2023
medline:
19
6
2023
pubmed:
19
6
2023
entrez:
19
6
2023
Statut:
epublish
Résumé
Evidence-based data on treatment of neonatal status epilepticus (SE) are scarce. We aimed to collect data on the efficacy and safety of ketamine for the treatment of neonatal SE and to assess its possible role in the treatment of neonatal SE. We described a novel case and conducted a systematic literature review on neonatal SE treated with ketamine. The search was carried out in Pubmed, Cochrane, Clinical Trial Gov, Scopus and Web of Science. Seven published cases of neonatal SE treated with ketamine were identified and analyzed together with our novel case. Seizures typically presented during the first 24 h of life (6/8). Seizures were resistant to a mean of five antiseizure medications. Ketamine, a NMDA receptor antagonist, appeared to be safe and effective in all neonates treated. Neurologic sequelae including hypotonia and spasticity were reported for 4/5 of the surviving children (5/8). 3/5 of them were seizure free at 1-17 months of life. Neonatal brain is more susceptible to seizures due to a shift towards increased excitation because of a paradoxical excitatory effect of GABA, a greater density of NMDA receptors and higher extracellular concentrations of glutamate. Status epilepticus and neonatal encephalopathy could further enhance these mechanisms, providing a rationale for the use of ketamine in this setting. Ketamine in the treatment of neonatal SE showed a promising efficacy and safety profile. However, further in-depth studies and clinical trials on larger populations are needed.
Sections du résumé
Background
UNASSIGNED
Evidence-based data on treatment of neonatal status epilepticus (SE) are scarce. We aimed to collect data on the efficacy and safety of ketamine for the treatment of neonatal SE and to assess its possible role in the treatment of neonatal SE.
Methods
UNASSIGNED
We described a novel case and conducted a systematic literature review on neonatal SE treated with ketamine. The search was carried out in Pubmed, Cochrane, Clinical Trial Gov, Scopus and Web of Science.
Results
UNASSIGNED
Seven published cases of neonatal SE treated with ketamine were identified and analyzed together with our novel case. Seizures typically presented during the first 24 h of life (6/8). Seizures were resistant to a mean of five antiseizure medications. Ketamine, a NMDA receptor antagonist, appeared to be safe and effective in all neonates treated. Neurologic sequelae including hypotonia and spasticity were reported for 4/5 of the surviving children (5/8). 3/5 of them were seizure free at 1-17 months of life.
Discussion
UNASSIGNED
Neonatal brain is more susceptible to seizures due to a shift towards increased excitation because of a paradoxical excitatory effect of GABA, a greater density of NMDA receptors and higher extracellular concentrations of glutamate. Status epilepticus and neonatal encephalopathy could further enhance these mechanisms, providing a rationale for the use of ketamine in this setting.
Conclusions
UNASSIGNED
Ketamine in the treatment of neonatal SE showed a promising efficacy and safety profile. However, further in-depth studies and clinical trials on larger populations are needed.
Identifiants
pubmed: 37334223
doi: 10.3389/fped.2023.1189478
pmc: PMC10275409
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
1189478Informations de copyright
© 2023 Pin, Leonardi, Nosadini, Cavicchiolo, Guariento, Zarpellon, Perilongo, Raffagnato, Toldo, Baraldi and Sartori.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Références
Epilepsia. 2011 Oct;52 Suppl 8:39-41
pubmed: 21967359
Pediatr Neurol. 2014 Jul;51(1):154-6
pubmed: 24938144
Pediatr Int. 2008 Feb;50(1):121-3
pubmed: 18279221
Arch Dis Child Fetal Neonatal Ed. 1994 Sep;71(2):F97-102
pubmed: 7979486
Anesthesiology. 2012 Feb;116(2):372-84
pubmed: 22222480
Lancet Child Adolesc Health. 2020 May;4(5):351-352
pubmed: 32336347
J Pediatr. 2016 Jul;174:98-103.e1
pubmed: 27106855
Pediatr Crit Care Med. 2010 May;11(3):343-8
pubmed: 20464775
Ann Trop Paediatr. 2004 Dec;24(4):345-7
pubmed: 15720892
CNS Neurol Disord Drug Targets. 2008 Apr;7(2):211-24
pubmed: 18537647
Intensive Care Med. 2008 Oct;34(10):1835-42
pubmed: 18604519
J Pediatr Neurol. 2009 Jan 1;7(1):5-12
pubmed: 20191097
Epilepsia. 2015 Oct;56(10):1515-23
pubmed: 26336950
Ann Neurol. 2006 Feb;59(2):411-5
pubmed: 16404748
Pediatr Neurol. 2020 May;106:76-77
pubmed: 32173160
Neurodiagn J. 2019;59(3):142-151
pubmed: 31433733
Anaesthesia. 2007 Dec;62 Suppl 1:48-53
pubmed: 17937714
Nat Rev Neurol. 2009 Jul;5(7):380-91
pubmed: 19578345
Neurology. 2022 Sep 20;99(12):e1227-e1238
pubmed: 35817569
BMJ Open. 2016 Jun 15;6(6):e011565
pubmed: 27311915
Pharmacol Rev. 1999 Mar;51(1):7-61
pubmed: 10049997
Pediatr Emerg Care. 2017 Aug;33(8):e24-e26
pubmed: 26247263
CNS Neurosci Ther. 2013 Jun;19(6):448-53
pubmed: 23462308
J Clin Neurophysiol. 2011 Dec;28(6):611-7
pubmed: 22146359
Pediatr Neurol. 2009 Nov;41(5):371-4
pubmed: 19818941
Neurotherapeutics. 2021 Jul;18(3):1564-1581
pubmed: 34386906
Nat Rev Neurol. 2022 Jul;18(7):428-441
pubmed: 35538233
Emerg Med Clin North Am. 2013 Aug;31(3):733-54
pubmed: 23915601
Intensive Care Med. 2021 Oct;47(10):1173-1174
pubmed: 34313797
Vaccine. 2019 Dec 10;37(52):7596-7609
pubmed: 31783981
Int J Clin Pract. 2011 Jan;65(1):27-30
pubmed: 21155941
Pediatr Neurol. 2012 Feb;46(2):111-5
pubmed: 22264706
Front Cell Neurosci. 2015 Sep 23;9:362
pubmed: 26441533
Lancet. 2006 Jul 15;368(9531):222-9
pubmed: 16844492
Neurology. 2020 Oct 20;95(16):e2286-e2294
pubmed: 32873691
Neurology. 2007 Nov 6;69(19):1816-22
pubmed: 17984448
J Clin Neurophysiol. 2012 Oct;29(5):441-8
pubmed: 23027101
J Neurosci. 2005 Jun 8;25(23):5511-20
pubmed: 15944379
Pediatr Neurol. 2010 Sep;43(3):221-4
pubmed: 20691948
BMC Pediatr. 2019 Apr 29;19(1):136
pubmed: 31035972
J Child Neurol. 2008 Mar;23(3):321-4
pubmed: 18182648
JAMA Pediatr. 2015 Apr;169(4):397-403
pubmed: 25685948
Curr Treat Options Neurol. 2019 Feb 18;21(2):8
pubmed: 30773607
J Physiol. 2004 Jun 15;557(Pt 3):829-41
pubmed: 15090604
Neurology. 2011 Jul 19;77(3):e16-9
pubmed: 21768594
Pediatr Neurol. 2020 Feb;103:8-11
pubmed: 31601453
Adv Neurol. 1999;79:189-201
pubmed: 10514814
Epilepsia. 2018 Apr;59(4):739-744
pubmed: 29399791
J Neurosci. 2003 Feb 1;23(3):876-82
pubmed: 12574416
Front Psychol. 2021 Jun 10;12:673529
pubmed: 34177731
Neurology. 2007 Dec 4;69(23):2177-85
pubmed: 18056582
Brain Dev. 2017 Aug;39(7):601-605
pubmed: 28325525
Neurology. 2000 Aug 22;55(4):506-13
pubmed: 10953181
Lancet Neurol. 2006 Sep;5(9):769-79
pubmed: 16914405
Br J Hosp Med (Lond). 2012 Oct;73(10):576-9
pubmed: 23124288
Epilepsia. 2021 Mar;62(3):615-628
pubmed: 33522601
Pediatrics. 2020 Jun;145(6):
pubmed: 32385134
J Neurosci. 1996 Oct 15;16(20):6414-23
pubmed: 8815920
Neurochem Res. 2018 Mar;43(3):566-580
pubmed: 29260492
Eur J Pediatr. 1995 Aug;154(8):649-53
pubmed: 7588967
Epilepsia. 2001 May;42(5):577-85
pubmed: 11380563
Neurology. 2015 Nov 3;85(18):1604-13
pubmed: 26296517
Pediatr Neurol. 2020 May;106:76
pubmed: 31917102
J Child Neurol. 2004 Jan;19(1):39-42
pubmed: 15032382
J Child Neurol. 2017 Jun;32(7):638-646
pubmed: 28349774
Ann Saudi Med. 1996 Jul;16(4):400-4
pubmed: 17372475
Semin Pediatr Neurol. 2019 Dec;32:100768
pubmed: 31813514
Pediatr Neonatol. 2020 Jun;61(3):300-305
pubmed: 31937508
Eur J Paediatr Neurol. 2015 May;19(3):314-9
pubmed: 25613545
J Child Neurol. 2016 Dec;31(14):1546-1554
pubmed: 27581850
Epileptic Disord. 2018 Dec 1;20(6):541-544
pubmed: 30530441