Efficacy of Intravenous Ketamine in Status Epilepticus: A Systematic Review and Meta-Analysis With Pediatric Subgroup Analysis.

Abstract

Status epilepticus (SE), particularly its refractory (RSE) and super-refractory (SRSE) forms, remains a critical neurological emergency with high morbidity and mortality, and treatment options become limited when conventional GABAergic anesthetics lose effectiveness or cause hemodynamic instability. Ketamine, through its antagonism of N-methyl-D-aspartate receptors, offers a mechanistically distinct and potentially advantageous therapeutic option. This systematic review and meta-analysis evaluated the efficacy of intravenous ketamine for terminating seizures in SE across adult and pediatric populations, synthesizing data from 10 studies involving 388 patients. A random-effects model demonstrated an overall seizure termination rate of 56% (95% CI: 51-61) with no heterogeneity. Subgroup analysis showed efficacy rates of 59% in adults and 50% in children, with no statistically significant difference between age groups, although adults showed a numerically higher response. Despite wide variability in dosing regimens and frequent use of concomitant anesthetics, seizure control was consistently observed across cohorts. Most included studies were of good methodological quality. These findings support intravenous ketamine as a clinically meaningful and hemodynamically favorable treatment option for RSE and SRSE when standard therapies fail and highlight the need for prospective, standardized, and especially pediatric-focused research to optimize dosing, timing, and long-term outcome assessment.

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