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Ketamine in seizure management and future pharmacogenomic considerations

The Pharmacogenomics Journal volume 20, pages 351–354 (2020)Cite this article

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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.

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Authors and Affiliations

  1. Pontifical Catholic University of Parana, R. Imaculada Conceição, 1155, Prado Velho, Curitiba – PR, 80215-901, Brazil

    Giovanna Soldatelli Borsato

  2. Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA

    Jason L. Siegel, Mariah Q. Rose, Michelle Ojard, Emily R. Rogers & William D. Freeman

  3. Department of Neurology, Mayo Clinic, Jacksonville, FL, USA

    Jason L. Siegel, Anteneh M. Feyissa & William D. Freeman

  4. Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA

    Jason L. Siegel, Alfredo Quinones-Hinojosa & William D. Freeman

  5. Department of Otorhinolaryngology, Mayo Clinic, Jacksonville, FL, USA

    Alfredo Quinones-Hinojosa

  6. Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA

    Alfredo Quinones-Hinojosa

  7. Department of Pharmacy, Mayo Clinic, Jacksonville, FL, USA

    Daniel A. Jackson

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  1. Giovanna Soldatelli Borsato
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  9. William D. Freeman
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Correspondence to William D. Freeman.

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Borsato, G.S., Siegel, J.L., Rose, M.Q. et al. Ketamine in seizure management and future pharmacogenomic considerations. Pharmacogenomics J 20, 351–354 (2020). https://doi.org/10.1038/s41397-019-0120-2

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