Super-Refractory Status Epilepticus: Role of Ketamine Infusion and Neuroimmunomodulation in Refractory Seizure Control
Year: 2026
Type: article
Abstract: SRSE (Super-Refractory Status Epilepticus) can be defined as a severe neurological emergency involving ongoing or repetitive convulsions despite being treated with established types of medications. The basis of SRSE is neuronal hyperexcitability along with disrupted processes of inhibition and stimulation in neurotransmission, processes of transporting receptors, and neuroinflammation with immune system influences. Ketamine substance becomes an efficient treatment, especially when standard anesthetics (often intended to stimulate activity of the neurotransmitter GABA) do not succeed. Ketamine affects excessive processes of stimulation due to which the medication allows to balance between inhibitory and excitatory processes regardless of the use of other anesthetics. Neuroinflammation and autoimmune processes can also play a role in obtaining refractoriness, therefore immunomodulatory may be applied to see whether patients with autoimmune etiology have an improvement in the clinical situation. Among possible methods of immunotherapy, the use of corticosteroids, immunoglobulins given intravenously, plasma exchange, and targeted immunotherapy may be indicated. The possibility of applying ketamine infusion together with immunomodulatory therapy seems to represent a feasible approach to treatment of SRSE and improving the quality of patients' rehabilitation, however, it is necessary to remember that monitoring the outcomes of the treatment is equally important.
Authors: Nujeti Vishnu Kumar, Gayam Ramprasad
Institution: Institut Nalanda
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7213639150