Recently I included a paper on ketamine for early status epilepticus treatment in the RACC-Lit review. Justin Morgenstern of First10EM disagreed with my conclusions in his research roundup for April 2025. So, I brought him on the podcast for a fun debate on the topic.
How Often Do Patients Continue Seizing Despite Benzos?
Rampart 25% still seizing after benzos, 27% still seizing after 10 mg midaz IM, 37% after ativan 4mg (NEJM 2012;366:591)
Papers Mentioned
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Othman AA, Sadek AA, Ahmed EA, Abdelkreem E. Combined Ketamine and Midazolam Versus Midazolam Alone for Initial Treatment of Pediatric Generalized Convulsive Status Epilepticus (Ket-Mid Study): A Randomized Controlled Trial. Pediatr Neurol. 2025 Jun;167:24-32. doi: 10.1016/j.pediatrneurol.2025.03.011. Epub 2025 Mar 22. PMID: [40186980]
- Burman RJ, Ackermann S, Shapson-Coe A, Ndondo A, Buys H, Wilmshurst JM. A Comparison of Parenteral Phenobarbital vs. Parenteral Phenytoin as Second-Line Management for Pediatric Convulsive Status Epilepticus in a Resource-Limited Setting. Front Neurol. 2019; 10. DOI: [10.3389/fneur.2019.00506]
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Scheppke KA, Pepe PE, Garay SA, Coyle CW, Antevy PM, Perlmutter MC, Scheppke EK, Crowe RP. Effectiveness of Ketamine As a Rescue Drug for Patients Experiencing Benzodiazepine-Resistant Status Epilepticus in the Prehospital Setting. Crit Care Explor. 2024 Dec 6;6(12):e1186. doi: 10.1097/CCE.0000000000001186. PMID: 39642307; PMCID: PMC11627481.
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Silbergleit R, Lowenstein D, Durkalski V, Conwit R; Neurological Emergency Treatment Trials (NETT) Investigators. RAMPART (Rapid Anticonvulsant Medication Prior to Arrival Trial): a double-blind randomized clinical trial of the efficacy of intramuscular midazolam versus intravenous lorazepam in the prehospital treatment of status epilepticus by paramedics. Epilepsia. 2011 Oct;52 Suppl 8(Suppl 8):45-7. doi: 10.1111/j.1528-1167.2011.03235.x. PMID: 21967361; PMCID: PMC3211107.
