Ketamine Infusion for Refractory Status Epilepticus—A Tale of Two Patients

Seizures are common at the end of life. Seizures can be especially distressing if they are refractory to conventional antiepileptic treatments. We present the histories of two terminally ill patients with refractory status epilepticus who did not respond to standard antiepileptic protocols. Seizure control was eventually achieved with the use of parenteral ketamine infusion dosed at 1 mg/kg/hour. Parenteral ketamine infusion is not traditionally used in palliative care for seizure management. However, our experience shows there is promise that it can be a viable option for refractory status epilepticus. For one of the patients, ketamine was initiated in the general ward setting. This highlights that seizure control can be achieved without a transfer to intensive care as such a transfer may not be consistent with a dying patient's goals of care. Further studies should be conducted in palliative care settings to evaluate the use of ketamine for terminal refractory status epilepticus.