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Early Research Suggests Ketamine Does Not Cause Neurocognitive Decline In Children

April 2, 2015

Dr. Amy-Lee Bredlau

Dr. Amy-Lee Bredlau

Used as an inexpensive, easy to administer anesthetic for years, the drug ketamine has been in the news lately for two related uses. While the World Health Organization has named ketamine to be an “essential medicine” that should be available to all health systems, it is also being abused by recreational drug users as a psychotropic. At the same time, new research is examining its use as a possible treatment for depression and chronic pain, when administered in therapeutic doses.

Before it can be approved for uses beyond anesthesia, more studies are required to understand ketamine’s long-term effect on neurocognitive function in both adults and children. In new research from the University of Rochester, ketamine was found to cause no decline in neurocognitive function in children suffering from chronic pain.

Despite some countries calling for a worldwide ban on ketamine, there has been promising evidence of its use to control pain in children and relieve symptoms of depression. Dr. Amy-Lee Bredlau has been studying ketamine’s effect on children for several years. As the Director of the Pediatric Brain Tumor Program at the Medical University of South Carolina, she wants to know if the drug will have any long-term effects on the developing brain.

“Children who have had multiple surgeries requiring anesthesia with (and without) ketamine have been noted to have neurocognitive delays,” Dr. Bredlau wrote in her latest research published in the Journal of Palliative Care and Medicine. “It has been impossible, to date, to determine if these neurocognitive delays are related to the ketamine, to the other anesthetic agents, or to a combination of both.”

With colleagues from the University of Rochester, Dr. Bredlau recruited 11 children, aged 11-19, who suffered from chronic abdominal pain, joint or musculoskeletal pain, headaches or allodynia. They were given low doses of ketamine, taken orally three times per day, for 14 days. Before the first dose, after the last dose two weeks later and again at week 14, all the children were given neurocognitive tests covering attention, processing speed, memory and executive function.

“If ketamine is going to be further developed as a medication with prolonged exposures, it is important to have an understanding of its neurocognitive toxicities,” wrote Dr. Bredlau.

For the cognitive assessments, Dr. Bredlau chose the Cogstate test battery, based on a recommendation from a colleague. Using computerized, visual stimuli that are easy for all ages and languages to understand, the children were tested using several Cogstate tests including, Detection Task, Identification Task, Groton Maze Chase Test, International Shopping List Test, One Back task, Set Shifting task and the Groton Maze Learning Test.

Working with the system for the first time, Dr. Bredlau was pleased with the quick, easy to understand format of the Cogstate battery, requiring no neuropsychologist to be present during testing. She looks forward to using the system in future research.

“Cogstate’s tests provide a thorough evaluation of neurocognitive abilities,” said Dr. Bredlau.

Comparing the 14-week test scores with the baselines, no decline in neurocognitive abilities were found in the children who received 14 days of low dose ketamine. While this was a first step that will require further testing with a larger, controlled population, Dr. Bredlau was encouraged with the results.

“On the basis of prior preclinical and preliminary clinical findings, the primary concern for administering low dosage ketamine to children has been the possibility of a resulting decrement in neurocognitive function,” wrote Dr. Bredlau.

“The data presented here do not support the hypothesis that oral ketamine administered three times daily at low doses for 14 days results in a sustained decrement in neurocognitive function, though participants did experience transient neurocognitive or neurologic adverse events while actively exposed to ketamine.”

Questions or comments?  Please contact Dan Peterson