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Pin JN, Leonardi L, Nosadini M, Cavicchiolo ME, Guariento C, Zarpellon A, Perilongo G, Raffagnato A, Toldo I, Baraldi E, Sartori S. Efficacy and safety of ketamine for neonatal refractory status epilepticus: case report and systematic review. Front Pediatr 2023; 11:1189478. [PMID: 37334223 PMCID: PMC10275409 DOI: 10.3389/fped.2023.1189478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
Background Evidence-based data on treatment of neonatal status epilepticus (SE) are scarce. We aimed to collect data on the efficacy and safety of ketamine for the treatment of neonatal SE and to assess its possible role in the treatment of neonatal SE. Methods We described a novel case and conducted a systematic literature review on neonatal SE treated with ketamine. The search was carried out in Pubmed, Cochrane, Clinical Trial Gov, Scopus and Web of Science. Results Seven published cases of neonatal SE treated with ketamine were identified and analyzed together with our novel case. Seizures typically presented during the first 24 h of life (6/8). Seizures were resistant to a mean of five antiseizure medications. Ketamine, a NMDA receptor antagonist, appeared to be safe and effective in all neonates treated. Neurologic sequelae including hypotonia and spasticity were reported for 4/5 of the surviving children (5/8). 3/5 of them were seizure free at 1-17 months of life. Discussion Neonatal brain is more susceptible to seizures due to a shift towards increased excitation because of a paradoxical excitatory effect of GABA, a greater density of NMDA receptors and higher extracellular concentrations of glutamate. Status epilepticus and neonatal encephalopathy could further enhance these mechanisms, providing a rationale for the use of ketamine in this setting. Conclusions Ketamine in the treatment of neonatal SE showed a promising efficacy and safety profile. However, further in-depth studies and clinical trials on larger populations are needed.
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Affiliation(s)
- Jacopo Norberto Pin
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
- Master in Pediatrics and Pediatric Subspecialties, University Hospital of Padua, Padova, Italy
| | - Letizia Leonardi
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Margherita Nosadini
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
- Neuroimmunology Group, Paediatric Research Institute “Città della Speranza”, Padova, Italy
| | - Maria Elena Cavicchiolo
- Department of Women’s and Children’s Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padova, Italy
| | - Chiara Guariento
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Anna Zarpellon
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Giorgio Perilongo
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Alessia Raffagnato
- Department of Women’s and Children’s Health, Child and Adolescent Neuropsychiatric Unit, University Hospital of Padua, Padova, Italy
| | - Irene Toldo
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
| | - Eugenio Baraldi
- Department of Women’s and Children’s Health, Neonatal Intensive Care Unit, University Hospital of Padua, Padova, Italy
| | - Stefano Sartori
- Department of Women’s and Children’s Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padova, Italy
- Master in Pediatrics and Pediatric Subspecialties, University Hospital of Padua, Padova, Italy
- Neuroimmunology Group, Paediatric Research Institute “Città della Speranza”, Padova, Italy
- Department of Neuroscience, University Hospital of Padua, Padova, Italy
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Bin Arif T, Ahmed J, Malik F, Nasir S, Khan TM. Neonatal Nonketotic Hyperglycinemia: A Rare Case from Pakistan. Cureus 2020; 12:e7235. [PMID: 32280576 PMCID: PMC7145377 DOI: 10.7759/cureus.7235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 12/22/2022] Open
Abstract
Nonketotic hyperglycinemia (NKH) is an autosomal recessive disorder caused by a defect in glycine cleavage enzyme. It leads to the accumulation of glycine in the body tissues, blood, and cerebrospinal fluid (CSF). Most NKH cases are diagnosed during the natal period of life and are fatal if not promptly diagnosed and managed. Here we present a case of a two-day-old child who presented with reluctant feeding and lethargy. She had reduced tone in all four limbs and a Glasgow Coma Scale score of 9. Keeping an infectious etiology in mind, she was started on cefotaxime and amikacin. The patient was shifted to the neonatal intensive care unit; however, no improvement in the patient's condition was seen and antibiotics were changed to linezolid and meropenem along with initiation of acyclovir. The patient's blood and CSF cultures were negative. Serum amino acid chromatography showed elevated levels of glycine, and a diagnosis of NKH was made. The patient was managed symptomatically but expired on the 22nd day of admission. The case highlights the importance of prompt diagnosis and management of aminoacidopathies. Nearly all metabolic disorders have similar clinical presentations, and an early diagnosis can improve the outcome in patients.
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Affiliation(s)
- Taha Bin Arif
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Jawad Ahmed
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Farheen Malik
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sharmeen Nasir
- Pediatrics, Dow University of Health Sciences, Karachi, PAK
| | - Taj M Khan
- Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, USA
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Alfadhel M, Al-Thihli K, Moubayed H, Eyaid W, Al-Jeraisy M. Drug treatment of inborn errors of metabolism: a systematic review. Arch Dis Child 2013; 98:454-61. [PMID: 23532493 PMCID: PMC3693126 DOI: 10.1136/archdischild-2012-303131] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The treatment of inborn errors of metabolism (IEM) has seen significant advances over the last decade. Many medicines have been developed and the survival rates of some patients with IEM have improved. Dosages of drugs used for the treatment of various IEM can be obtained from a range of sources but tend to vary among these sources. Moreover, the published dosages are not usually supported by the level of existing evidence, and they are commonly based on personal experience. METHODS A literature search was conducted to identify key material published in English in relation to the dosages of medicines used for specific IEM. Textbooks, peer reviewed articles, papers and other journal items were identified. The PubMed and Embase databases were searched for material published since 1947 and 1974, respectively. The medications found and their respective dosages were graded according to their level of evidence, using the grading system of the Oxford Centre for Evidence-Based Medicine. RESULTS 83 medicines used in various IEM were identified. The dosages of 17 medications (21%) had grade 1 level of evidence, 61 (74%) had grade 4, two medications were in level 2 and 3 respectively, and three had grade 5. CONCLUSIONS To the best of our knowledge, this is the first review to address this matter and the authors hope that it will serve as a quickly accessible reference for medications used in this important clinical field.
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Affiliation(s)
- Majid Alfadhel
- Division of Genetics, Department of Pediatrics, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, PO Box 22490, Riyadh 11426, Saudi Arabia.
| | - Khalid Al-Thihli
- Genetics and Developmental Medicine Clinic, Sultan Qaboos University Hospital, Muscat, Sultanate ofOman
| | - Hiba Moubayed
- Pharmaceutical Care Services, Division of Clinical Pharmacy, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Wafaa Eyaid
- Division of Genetics, Department of Pediatrics, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Majed Al-Jeraisy
- Pharmaceutical Care Services, Division of Clinical Pharmacy, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Arnold GL, Griebel ML, Valentine JL, Koroma DM, Kearns GL. Dextromethorphan in nonketotic hyperglycinaemia: metabolic variation confounds the dose-response relationship. J Inherit Metab Dis 1997; 20:28-38. [PMID: 9061564 DOI: 10.1023/a:1005301321635] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Nonketotic hyperglycinaemia (NKH) is an inborn error of the glycine cleavage system resulting in seizures and mental retardation. Two prior reports noted an anticonvulsant effect from high-dose dextromethorphan (DM) in this disorder, although the two reported patients demonstrated widely disparate DM requirements and drug levels. We report two children with NKH who also demonstrated disparate and variable DM metabolism which markedly influenced the dose-concentration-response relationship. Levels of DM and its primary metabolite dextrorphan (DX) were utilized to guide DM therapy and exhibited patterns reflective of the extensive and poor metabolizer phenotypes for CYP2D6, the cytochrome P450 isoform responsible for DM metabolism. In the patient who appeared to represent the extensive metabolizer (EM) phenotype, treatment with the non-specific cytochrome P450 inhibitor cimetidine was required to reduce biotransformation of DM to DX and, thus, to increase DM plasma concentrations. In the patient with the apparent poor metabolizer (PM) phenotype, a change in the DM preparation to a sustained-release form and increase in the dosing interval was required to lower DM plasma concentrations. These cases demonstrate the importance of CYP2D6 phenotype in providing safe and effective DM therapy to patients with NKH.
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Affiliation(s)
- G L Arnold
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, New York 14642, USA
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