Wayne State University/Detroit Medical Center, United States.
Wayne State University/Detroit Medical Center, United States.
Epilepsy Behav. 2022 Dec;137(Pt A):108954. doi: 10.1016/j.yebeh.2022.108954. Epub 2022 Nov 11.
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.
To assess clinical and electrographic outcomes in patients receiving dual antiglutamatergic therapy in SE.
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.
Dual anti-glutamatergic therapy could provide a favorable approach to treating SE, which yet needs to be further investigated through larger randomized control studies.
癫痫持续状态（SE）仍然是一种具有高发病率和死亡率的挑战性神经急症。在治疗过程中，采用了不同的方案，涵盖了所有已知的终止癫痫发作的机制。据我们所知，这是首例描述同时使用氯胺酮和吡仑帕奈（PER）治疗的患者的脑电图模式和临床结果的病例系列报告。
评估 SE 患者接受双重抗谷氨酸能治疗的临床和脑电图结果。
25 例患者中有 21 例接受了氯胺酮治疗，4 例患者联合使用了 PER。在氯胺酮加 PER 组中，4 例患者中有 3 例为惊厥性 SE，1 例为非惊厥性 SE，而氯胺酮组中 8 例患者为 NCSE。在开始使用氯胺酮和 PER 后，脑电图上出现β模式的发生率在所有 4 例患者（100%）中均高于其他组（61.9%）。在接受氯胺酮和 PER 治疗的患者中，75%记录到爆发抑制模式，而在接受不同方案治疗的患者中，这一比例为 28.5%。氯胺酮组 SE 缓解时间明显短于其他组（中位数 24（24-64）小时与 6（05-144）小时，p > 0.05）。此外，同时使用 PER 的患者静脉麻醉天数略低。在发病率方面，氯胺酮和 PER 组的平均 mRS 增加也较低，尽管这并不具有统计学意义。
双重抗谷氨酸能治疗可能是治疗 SE 的一种有利方法，但还需要通过更大的随机对照研究进一步探讨。
