1.
Ketamine in seizure management and future pharmacogenomic considerations.
Borsato, GS, Siegel, JL, Rose, MQ, Ojard, M, Feyissa, AM, Quinones-Hinojosa, A, Jackson, DA, Rogers, ER, Freeman, WD
The pharmacogenomics journal. 2020;(3):351-354
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.
2.
Ketamine Infusion Combined With Magnesium as a Therapy for Intractable Chronic Cluster Headache: Report of Two Cases.
Moisset, X, Clavelou, P, Lauxerois, M, Dallel, R, Picard, P
Headache. 2017;(8):1261-1264
Abstract
BACKGROUND Chronic cluster headache (CH) is a rare, highly disabling primary headache condition. As NMDA receptors are possibly overactive in CH, NMDA receptor antagonists, such as ketamine, could be of interest in patients with intractable CH. CASE REPORTS Two Caucasian males, 28 and 45 years-old, with chronic intractable CH, received a single ketamine infusion (0.5 mg/kg over 2 h) combined with magnesium sulfate (3000 mg over 30 min) in an outpatient setting. This treatment led to a complete relief from symptoms (attack frequency and pain intensity) for one patient and partial relief (50%) for the other patient, for 6 weeks in both cases. CONCLUSION The NMDA receptor is a potential target for the treatment of chronic CH. Randomized, placebo-controlled studies are warranted to establish both safety and efficacy of such treatment.
3.
Ketamine: an introduction for the pain and palliative medicine physician.
Okon, T
Pain physician. 2007;(3):493-500
Abstract
A history of an escalating chronic intractable pain in a patient with cryoglobulinemia, vasculitis, and severe cutaneous ulcerations is presented. A strategy of progressive, multi-agent, N-methyl-D-aspartate-receptor (NMDA-R) blockade that resulted in adequate pain control and a three-fold reduction in opioid consumption is described. Diagnostic process of neuropathic pain and the role of NMDA-R in the development of hyperalgesia are briefly reviewed. Thereafter, existing clinical literature describing the use of Ketamine, a major NMDA-R antagonist for management of malignant pain, is reviewed. Lastly, evidence-based original protocol for intravenous adjuvant Ketamine analgesia for severe cancer pain is presented.
5.
Gabapentin for painful legs and moving toes syndrome.
Villarejo, A, Porta-Etessam, J, Camacho, A, González De La Aleja, J, Martínez-Salio, A, Penas, M
European neurology. 2004;(3):180-1
6.
Gabapentin attenuates superior oblique myokymia.
Tomsak, RL, Kosmorsky, GS, Leigh, RJ
American journal of ophthalmology. 2002;(5):721-3
Abstract
PURPOSE To investigate therapeutic effects of oral gabapentin therapy on superior oblique myokymia. DESIGN Observational case series with measurement of visual acuity and eye movements before, during, and after therapy. METHODS Two adult patients with superior oblique myokymia, refractory to other therapies, were treated with gabapentin orally after informed consent was obtained. Eye movements were measured using the magnetic search coil technique. RESULTS Superior oblique myokymia completely resolved after starting gabapentin. CONCLUSION Gabapentin may be an effective treatment for superior oblique myokymia; a double-blind study seems justified.