CCRP Critical Care Research and Practice 2090-1313 2090-1305 Hindawi Publishing Corporation 10.1155/2015/831260 831260 Review Article Early Use of the NMDA Receptor Antagonist Ketamine in Refractory and Superrefractory Status Epilepticus Zeiler F. A. umzeiler@cc.umanitoba.ca Tisherman Samuel A. Section of Neurosurgery Department of Surgery University of Manitoba Winnipeg, MB Canada R3A 1R9 umanitoba.ca 2015 12 1 2015 2015 02 09 2014 24 12 2014 12 1 2015 2015 Copyright © 2015 F. A. Zeiler. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Refractory status epilepticus (RSE) and superrefractory status epilepticus (SRSE) pose a difficult clinical challenge. Multiple cerebral receptor and transporter changes occur with prolonged status epilepticus leading to pharmacoresistance patterns unfavorable for conventional antiepileptics. In particular, n-methyl-d-aspartate (NMDA) receptor upregulation leads to glutamate mediated excitotoxicity. Targeting these NMDA receptors may provide a novel approach to otherwise refractory seizures. Ketamine has been utilized in RSE. Recent systematic review indicates 56.5% and 63.5% cessation in seizures in adults and pediatrics, respectively. No complications were described. We should consider earlier implementation of ketamine or other NMDA receptor antagonists, for RSE. Prospective study of early implementation of ketamine should shed light on the role of such medications in RSE.