case_images: PMC10291615_01
case_images: 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)].
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case_images: PMC10291615_01_fnins-17-1197409-g001.jpg
case_images: fig1
case_images: Beginning in 2018, the patient began experiencing seizure-like episodes occasionally associated with feelings of dissociation (Figure 1). Subsequently, she developed a benzodiazepine dependance and had a suicide attempt with an overdose of benzodiazepines in late 2019 (Figure 1).
case_images: 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.
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case_images: PMC10291615_01_fnins-17-1197409-g002.jpg
case_images: fig2
case_images: In line with the standard NCT protocol for KAT, the patient underwent three 90-min preparatory sessions, three ketamine sessions with increasing doses (130-260 mg total of combined SL and IN routes; IN dose administered as a supplemental dose 20 min after SL administration, in accordance with patient comfort; Figure 2).
case_images: (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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case_images: PMC10291615_01_fnins-17-1197409-g003.jpg
case_images: fig3
case_images: At the time of writing this report, the patient experienced two minor seizures in the last 3 weeks as compared to 7-21 per week prior to KAT (Figure 3). Prior to KAT, WSAS and QIDS scores were clinically significant and dropped to levels of insignificance following the latest maintenance session (Figure 3).