Ketogenic diet treatment for pediatric super-refractory status epilepticus. (October 2016)

• Record Type: Journal Article
• Authors: Appavu, Brian; Vanatta, Lisa; Condie, John; Kerrigan, John F.; Jarrar, Randa
• Is Part Of: Seizure. Volume 41(2016)
• Page Start: 62
• Page End: 65
• Publication Date: 2016-10
• Subjects: Super refractory status epilepticus -- Ketogenic diet -- Encephalitis -- Epilepsy -- Pediatrics; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2016.07.006
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: 10 children received the ketogenic diet for super-refractory status epilepticus. 9 children had resolution of status epilepticus after diet therapy. Only one child had side effects associated with the ketogenic diet. The ketogenic diet could be useful in treating super-refractory status epilepticus. Abstract: Purpose: We aimed to study whether ketogenic diet (KD) therapy leads to resolution of super-refractory status epilepticus in pediatric patients without significant harm. Method: A retrospective review was performed at Phoenix Children's Hospital on patients with super-refractory status epilepticus undergoing ketogenic diet therapy from 2011 to 2015. Results: Ten children with super-refractory status epilepticus, ages 2–16 years, were identified. 4/10 patients had immune mediated encephalitis, including Rasmussen encephalitis, anti- N -methyl-d -aspartate receptor encephalitis, and post-infectious mycoplasma encephalitis. Other etiologies included Lennox Gastaut Syndrome, non-ketotic hyperglycinemia, PCDH19 and GABRG2 genetic epilepsy, New Onset Refractory Status Epilepticus, and Febrile Infection-Related Epilepsy Syndrome. 4/10 patients' EEG features suggested focal with status epilepticus, and 6/10 suggested generalized with status epilepticus. Median hospital length was 61 days and median ICU length was 27 days. The median number of antiepileptic medications prior to diet initiation was 3.0 drugs, and the median after ketogenic diet treatment was 3.5 drugs. Median duration of status epilepticus prior to KD was 18 days. 9/10 patients had resolution of super-refractory status epilepticus in a median of 7 days after diet initiation. 8/9 patients were weaned off anesthesia within 15 days of diet initiation, and within 1 day of achieving ketonuria. 1/10 patients experienced side effects on the diet requiring supplementation. Conclusion: Most patients achieved resolution of status epilepticus on KD therapy, suggesting it could be an effective therapy that can be utilized early in the treatment of children with super refractory status epilepticus.