Phase I/II multicenter ketogenic diet study for adult superrefractory status epilepticus. (7th March 2017)

• Record Type: Journal Article
• Authors: Cervenka, Mackenzie C.; Hocker, Sara; Koenig, Matthew; Bar, Barak; Henry-Barron, Bobbie; Kossoff, Eric H.; Hartman, Adam L.; Probasco, John C.; Benavides, David R.; Venkatesan, Arun; Hagen, Eliza C.; Dittrich, Denise; Stern, Tracy; Radzik, Batya; Depew, Marie; Caserta, Filissa M.; Nyquist, Paul; Kaplan, Peter W.; Geocadin, Romergryko G.
• Is Part Of: Neurology. Volume 88:Number 10(2017)
• Publication Date: 2017-03-07
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000003690
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Objective: To investigate the feasibility, safety, and efficacy of a ketogenic diet (KD) for superrefractory status epilepticus (SRSE) in adults. Methods: We performed a prospective multicenter study of patients 18 to 80 years of age with SRSE treated with a KD treatment algorithm. The primary outcome measure was significant urine and serum ketone body production as a biomarker of feasibility. Secondary measures included resolution of SRSE, disposition at discharge, KD-related side effects, and long-term outcomes. Results: Twenty-four adults were screened for participation at 5 medical centers, and 15 were enrolled and treated with a classic KD via gastrostomy tube for SRSE. Median age was 47 years (interquartile range [IQR] 30 years), and 5 (33%) were male. Median number of antiseizure drugs used before KD was 8 (IQR 7), and median duration of SRSE before KD initiation was 10 days (IQR 7 days). KD treatment delays resulted from intravenous propofol use, ileus, and initial care received at a nonparticipating center. All patients achieved ketosis in a median of 2 days (IQR 1 day) on KD. Fourteen patients completed KD treatment, and SRSE resolved in 11 (79%; 73% of all patients enrolled). Side effects included metabolic acidosis, hyperlipidemia, constipation, hypoglycemia, hyponatremia, and weight loss. Five patients (33%) ultimately died. Conclusions: KD is feasible in adults with SRSE and may be safe and effective. Comparative safety and efficacy must be established with randomized placebo-controlled trials. Classification of evidence: This study provides Class IV evidence that in adults with SRSE, a KD is effective in inducing ketosis.