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Case Reports
. 2023 Jun 12:17:1197409.
doi: 10.3389/fnins.2023.1197409. eCollection 2023.

Case report: Improvement in refractory functional seizures, depression, and quality of life with ketamine-assisted therapy

Affiliations
Case Reports

Case report: Improvement in refractory functional seizures, depression, and quality of life with ketamine-assisted therapy

Elena Argento et al. Front Neurosci. .

Abstract

Functional seizures, a primary subtype of functional neurological disorder (FND), are a known cause of serious neurological disability with an increasing awareness of their impact amongst the neuroscience community. Situated at the intersection of neurology and psychiatry, FND is characterized by a range of alterations in motor, sensory or cognitive performance, such as abnormal movements, limb weakness, and dissociative, seizure-like episodes. Functional seizures are known, in part, to have psychological underpinnings; however, the lack of effective and consistent treatment options requires research and novel approaches to better understand the etiology, diagnosis and what constitutes a successful intervention. Ketamine, a selective blocker of the N-methyl-D-aspartate receptor, has a well-established safety and efficacy profile. In recent years, ketamine-assisted therapy has shown increasing potential for treating a broad range of psychiatric conditions, building on its demonstrated rapid-acting antidepressant effects. Here we present a 51-year-old female with refractory daily functional seizures leading to significant disability and a medical history significant for major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). After unsuccessful treatment attempts, the patient underwent a novel protocol with ketamine-assisted therapy. After 3 weeks of ketamine-assisted therapy followed by 20 weeks of intermittent ketamine treatment and ongoing integrative psychotherapy, the patient's seizures were significantly reduced in frequency and severity. She experienced significant improvements in depressive symptoms and functional ability scores. To our knowledge, this is the first reported case describing improvement in functional seizures following ketamine-assisted therapy. While rigorous studies are needed, this case report encourages further investigation of ketamine-assisted therapy for functional seizures and other functional neurological symptoms.

Keywords: functional neurological disorder; functional seizures; ketamine-assisted therapy; mental health; quality of life.

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Conflict of interest statement

EA was a part-time consultant to Numinus Wellness Inc. and AJ, AK, KM, PT, CN, and EL were employed by the company Numinus Wellness Inc. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Timeline of case including client history highlighting relevant trauma, behavior, and symptoms. Dark green block designates time during ketamine-assisted therapy protocol and light green block designates ketamine maintenance. Dates along the bottom specify years of onset, with brackets expressing span of time. Yellow bubbles indicate function seizure severity, blue bubbles indicate benzodiazepine use, and red/orange bubbles emphasize pre- and post- case depression measures [Quick Inventory of Depressive Symptomatology (QIDS) measure and Work and Social Adjustment Score (WSAS)].
Figure 2
Figure 2
Ketamine-assisted therapy and maintenance over time. Timeline of treatment shown in weeks. Dark green indicates a ketamine-assisted therapy session, light green indicates ketamine maintenance session, gray indicates an interval update session, and blue checkmarks outside of dosing sessions indicate psychotherapy sessions. The standard NCT ketamine protocol consists of three 90-min preparatory sessions, three KAT sessions, and three 75-min integration sessions (1 day after KAT session). Maintenance sessions included treatment with ketamine overseen by a nurse with no therapist present. Sixty-minutes psychotherapy sessions followed as per the treating therapist recommendation. Breaks in timeline indicate weeks without any visits. For KAT treatment sessions, ketamine was administered sublingually (SL) at the beginning of the visit, and intranasally (IN) as a supplemental dose at 20 min. For maintenance sessions, the SL and IN dose are given at the beginning of the visit, with no supplemental dose. Interval update sessions include a phone check-in with the nurse.
Figure 3
Figure 3
(A) Functional seizure frequency reported in number of seizures per week over the course of treatment and maintenance sessions as reported in participant seizure diary. Red indicates strong seizure severity, blue indicates mild seizure severity, and yellow indicates a mix of both types of seizure severity. No data on seizure frequency week 2 and 3 are due to missed data collection. (B) The Quick Inventory of Depressive Symptomatology (QIDS) and (C) Work and Social Adjustment Score (WSAS) measure over time. The QIDS and WSAS were administered at every treatment, maintenance, and interval update visit. Dark green indicates a ketamine-assisted therapy session, light green indicates ketamine maintenance session, and gray indicates an interval update session. No data on WSAS week 23 is due to missed measure administration. Breaks in timeline indicate weeks without any visits.

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