From the Research
Ketamine may be considered for managing severe behavioral symptoms in pediatric patients with neurodegenerative disorders and dementia when conventional treatments have failed, but its use remains investigational in this population. The most recent and highest quality study, 1, suggests that the current evidence for using ketamine in individuals with dementia is limited, and high-quality prospective studies are needed to confirm its effectiveness. However, in the context of real-life clinical medicine, ketamine may be considered as a last resort for severe behavioral symptoms.
For acute agitation or aggression, low-dose ketamine (0.5-1 mg/kg IV or IM) may be administered under close medical supervision, typically in an inpatient or emergency setting, as part of a comprehensive treatment plan that includes behavioral interventions, environmental modifications, and management of underlying symptoms. The study 2 highlights the importance of a comprehensive approach in managing pediatric neurodegenerative disorders, which includes addressing neuropsychiatric manifestations such as irritability, aggression, and self-injury.
It is essential to note that ketamine works by antagonizing NMDA receptors, potentially modulating glutamate transmission and reducing neuronal hyperexcitability that may contribute to behavioral disturbances, as suggested by the study 1. However, close monitoring for side effects is crucial, including dissociative symptoms, increased heart rate and blood pressure, and potential long-term effects on developing brains.
The treatment duration should be limited, with regular reassessment every 2-4 weeks, and informed consent from caregivers should be obtained, acknowledging the off-label nature of this treatment. The study 3 emphasizes the importance of a "start low, go slow" philosophy in pharmacologic treatments, which is particularly relevant when considering the use of ketamine in pediatric patients.
In summary, while the evidence for using ketamine in pediatric patients with neurodegenerative disorders and dementia is limited, it may be considered as part of a comprehensive treatment plan when conventional treatments have failed, with careful monitoring and informed consent.