Status epilepticus (SE) is a critical pediatric neurological emergency that requires rapid and effective management to prevent significant morbidity and mortality. While benzodiazepines and traditional antiepileptic drugs (AEDs) remain the mainstays of initial treatment, their efficacy diminishes with prolonged seizure activity. Ketamine, an NMDA receptor antagonist, has emerged as a promising option, particularly in refractory and super-refractory SE cases. We report a 30-month-old male patient with a history of neuroglial tumor resection who presented with fever and diarrhea and subsequently developed febrile SE unresponsive to standard treatment protocols, including benzodiazepines, levetiracetam, phenytoin, and high-dose midazolam infusion. Early initiation of ketamine infusion prior to intubation resulted in immediate seizure cessation and stabilization. This case highlights the potential utility of early ketamine administration in the management of pediatric SE, especially in benzodiazepine-resistant scenarios. Our findings support the growing body of literature advocating for the integration of ketamine into early treatment algorithms for refractory SE. Further randomized controlled studies are warranted to define optimal dosing strategies and evaluate long-term neurological outcomes associated with ketamine use in this context.
Yildiz et al. (Fri,) studied this question.