Ketamine for Established Status Epilepticus Treatment Trial (KESETT)

Status epilepticus is one of the most common neurologic emergencies; 120,000 to 180,000 episodes are treated annually in United States emergency departments. Benzodiazepines are widely recognized as effective first-line therapy, but the optimal second-line therapy is unknown. Prospective open-label pediatric trials in the United Kingdom and Australasia found approximately equivalent response rates comparing phenytoin to levetiracetam. The success of second-line agents is important because prolongation of status epilepticus itself leads to increasing likelihood of further seizure activity through positive feedback mechanisms. Failure to stop SE early is associated with irreversible neuronal injury and the complications caused by metabolic and respiratory derangements of SE.