Electroencephalography Correlation of Ketamine-induced Clinical Excitatory Movements: A Systematic Review.

A systematic review of eight studies with 141 subjects found that ketamine administration for procedural sedation frequently triggered electrographic seizures in people with epilepsy, but never in those without. Among 94 subjects with epilepsy, 28% had seizures detectable on EEG after ketamine, compared with 0% of 39 subjects without epilepsy. Clinical excitatory movements were also more common in the epilepsy group (14% vs 5%) and were usually time-linked to the EEG seizures. Children with epilepsy appeared more susceptible than adults. The authors suggest clinicians consider a patient's seizure history when discussing the risks and benefits of ketamine sedation.

Study at a glance

Abstract

This is a systematic review investigating the correlation between seizures identifiable on electroencephalogram (EEG), clinical excitatory movements (CEM), and ketamine administration for procedural sedation. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and Web of Science in April 2021. Search terms included variations for ketamine, myoclonus, seizures, status epilepticus, and electroencephalography. Two independent reviewers assessed papers based on eligibility criteria, which included human studies where EEG recordings were obtained during ketamine administration. Eight papers were eligible for inclusion with 141 subjects (24 children). Seven studies (133 subjects) reported epilepsy history; 70% (94/133) of these subjects had a pre-existing epilepsy diagnosis. No (0/39) subjects without epilepsy and 28% (26/94) of subjects with epilepsy had electrographic seizures after ketamine administration. In four studies where pediatric and adult subjects could be separated, children with epilepsy had electrographic seizures in 60% (3/5) of cases compared to 28% (6/33) of cases of adults with epilepsy. Of the subjects with epilepsy, 14% (10/74) had CEMs vs 5% (1/21) in subjects without epilepsy. Most CEMs (9/11) were temporally correlated with electrographic seizures. Our findings indicate that in subjects with epilepsy, electrographic seizures were frequently seen with ketamine administration and were correlated with CEMs. No seizure activity after ketamine was seen in subjects without epilepsy. While the clinical significance of these findings needs further investigation, clinicians may want to consider patients' seizure history when providing counseling on the risks and benefits of ketamine sedation.