Ketamine in seizure management and future pharmacogenomic considerations

Pharmacogenomics J. 2020 Jun;20(3):351-354. doi: 10.1038/s41397-019-0120-2. Epub 2019 Nov 27.

Abstract

Ketamine is a noncompetitive N-methyl-D-aspartate antagonist with emerging evidence for use in medically refractory epilepsy. We describe the novel use of low-dose intravenous (IV) ketamine transitioning to enteral formulation in a patient with drug-resistant localization-related refractory epilepsy. We performed a National Library of Medicine (NLM) literature review using search terms "ketamine", "low dose", and "seizure" for similar cases, followed by an illustrative clinical case. Our NLM search engine methodology yielded 24 hits, none of which described use of low-dose ketamine for seizures. Anesthetic doses are used for status epilepticus, but we show that in a patient with postoperative worsening of his chronic seizure burden, low-dose IV ketamine can be used to avoid oversedation and intubation. We demonstrate that IV ketamine can be transitioned to oral regimen to shorten length of stay in the intensive care unit and hospital and has future CYP2B6 pharmacogenomic considerations for further dose individualization.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Anticonvulsants / administration & dosage
  • Disease Management*
  • Drug Resistant Epilepsy / drug therapy*
  • Drug Resistant Epilepsy / genetics
  • Drug Therapy, Combination
  • Excitatory Amino Acid Antagonists / administration & dosage*
  • Forecasting
  • Humans
  • Ketamine / administration & dosage*
  • Male
  • Pharmacogenetics / trends*
  • Seizures / drug therapy*
  • Seizures / genetics
  • Young Adult

Substances

  • Anticonvulsants
  • Excitatory Amino Acid Antagonists
  • Ketamine