Ketamine for the treatment of refractory status epilepticus

• Ketamine plays an anticonvulsant role via antagonism of NMDA receptors.
• Ketamine appears to be effective on refractory SE but based on low level of evidence.
• Ketamine is often selected after 5–6 anticonvulsants have failed.
• Ketamine administration involves intravenous and oral routes.
• Ketamine is rapid onset and relatively safe for refractory status epilepticus.

Status epilepticus (SE) is an acute and severe illness of the central nervous system, and prolonged SE can lead to brain damage and even death. Ketamine is a noncompetitive antagonist of glutamatergic N-methyl-d-aspartate (NMDA) receptors. During prolonged seizures, the numbers and activities of GABA receptors gradually decrease; thus, the commonly used first-line and second-line antiepileptic drugs gradually fail. Simultaneously, the numbers and activities of glutamatergic NMDA receptors increase, often causing refractory status epilepticus (RSE) and thus providing the possibility of the use of ketamine to treat RSE. To improve the prognosis of SE, we present a narrative review of ketamine for the treatment of RSE in the extant literature. We draw the conclusion that ketamine appears to be effective and relatively safe for the control of multidrug-resistant RSE in children and adults.