Ketogenic Diet in Status Epilepticus

2016 ◽  
Author(s):  
Rima Nabbout
Keyword(s):  
Intensive Care ◽  
Status Epilepticus ◽  
Intensive Care Units ◽  
Ketogenic Diet ◽  
Significant Risk ◽  
Refractory Status Epilepticus ◽  
Dietary Therapy ◽  
Risk Of Death ◽  
Refractory Status ◽  
Neurological Morbidity

Refractory status epilepticus (RSE) is associated with a significant risk of death or neurological morbidity. The ketogenic diet (KD) is a dietary therapy that succeeds in controlling seizures in otherwise RSE in children and adult patients. Inflammatory etiologies might be a particular target, but KD has reported efficacy in other etiologies. KD is well tolerated, and the effect is seen within days. Randomized and controlled studies are lacking in this area, and studies are needed to prove the efficacy of KD in RSE and to identify specific indications. This would help to increase its use and to implement it in intensive care units to resolve severe epileptic conditions quickly.

scholarly journals Consensus Protocol for the Treatment of Super-Refractory Status Epilepticus

2018 ◽  
Vol 31 (10) ◽  
pp. 598 ◽  
Author(s):  
Daniel Gomes ◽  
José Pimentel ◽  
Carla Bentes ◽  
Diana Aguiar de Sousa ◽  
Ana Patrícia Antunes ◽  
...  
Keyword(s):  
Intensive Care ◽  
Status Epilepticus ◽  
Intensive Care Units ◽  
Case Reports ◽  
Treatment Protocol ◽  
Treatment Strategies ◽  
Refractory Status Epilepticus ◽  
Consensus Protocol ◽  
Level Of Evidence ◽  
Refractory Status

Introduction: Super-refractory status epilepticus is defined as status epilepticus that persists or recurs 24 hours after anaesthetic therapy onset or after its withdrawal. It is mostly found in intensive care units and carries high mortality but good long-term prognosis for those who survive. In contrast with the initial phases of status epilepticus, treatment lacks strong scientific evidence and is mostly derived from case reports or small case series.Objective: To propose a protocol for the treatment of super-refractory status epilepticus in level III intensive care units, focusing on the treatment strategies to control clinical and/or electroencephalographic epileptic activity.Material and Methods: Narrative review of the literature by PubMed search. Available evidence was discussed in consensus meetings by intensive care and neurology experts’ from a level III intensive care unit and one of the Portuguese reference centres for the treatment of refractory epilepsy, respectively.Results: Anaesthetics with the highest level of evidence are propofol, midazolam, thiopental and ketamine. These represent the basis of the treatment of super-refractory status epilepticus and should be used in combination with antiepileptic drugs. The level of evidence for the latter is lower, however, levetiracetam, topiramate, pregabalin, lacosamide, valproic acid, phenytoin and perampanel may be recommended. Alternative therapeutic strategies with very low level of evidence are recommended in cases of total absence of clinical response, such as magnesium sulphate, pyridoxine, ketogenic diet, therapeutic hypothermia and immunosupression.Conclusion: We propose a treatment protocol based on a sequential combination of anaesthetics, anti-epileptic drugs and alternative therapies. Strategies to evaluate treatment response and to wean drugs based on clinical results are also proposed.

Practical considerations for ketogenic diet in adults with super refractory status epilepticus

2020 ◽  
pp. 10.1212/CPJ.0000000000001009
Author(s):  
Neha Kaul ◽  
Joshua Laing ◽  
John-Paul Nicolo ◽  
Judy Nation ◽  
Patrick Kwan ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Ketogenic Diet ◽  
Diet Therapy ◽  
Refractory Status Epilepticus ◽  
Current Evidence ◽  
Dietary Therapy ◽  
Effective Treatment Option ◽  
Acute Setting ◽  
Refractory Status ◽  
Metabolic Interactions

ABSTRACTPURPOSE OF REVIEWKetogenic diet therapy can be utilized as an adjuvant treatment of super refractory status epilepticus (SRSE). However, the drug and metabolic interactions with concomitant treatments present a challenge for clinicians. In this review we focus on the practical considerations of implementing ketogenic dietary therapy in the acute setting, including the dietary composition, potential drug-diet interactions, and monitoring during ketogenic treatment.RECENT FINDINGSThis report describes the ketogenic diet therapy protocol implemented for the treatment of SRSE and a review of the current evidence to support clinical practice.SUMMARYThe control of SRSE is critical in reducing morbidity and mortality. There is emerging evidence that ketogenic diet may be a safe and effective treatment option for these patients.

scholarly journals The Feasibility, Safety and Effectiveness of a Ketogenic Diet for Refractory Status Epilepticus in Adults in the Intensive Care Unit

2018 ◽  
Vol 30 (3) ◽  
pp. 652-657 ◽  
Author(s):  
Brandon A. Francis ◽  
Jennifer Fillenworth ◽  
Philip Gorelick ◽  
Kristina Karanec ◽  
Adriana Tanner
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Ketogenic Diet ◽  
Refractory Status Epilepticus ◽  
Refractory Status

A Practical Approach to Ketogenic Diet in the Pediatric Intensive Care Unit for Super-Refractory Status Epilepticus

2016 ◽  
Vol 26 (2) ◽  
pp. 267-272 ◽  
Author(s):  
Raquel Farias-Moeller ◽  
Luca Bartolini ◽  
Archana Pasupuleti ◽  
R. D. Brittany Cines ◽  
Amy Kao ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Pediatric Intensive Care Unit ◽  
Ketogenic Diet ◽  
Pediatric Intensive Care ◽  
Refractory Status Epilepticus ◽  
Practical Approach ◽  
Refractory Status

scholarly journals Ketogenic Diet in the Treatment of Super-Refractory Status Epilepticus at a Pediatric Intensive Care Unit: A Single-Center Experience

2021 ◽  
Vol 12 ◽  
Author(s):  
Markus Breu ◽  
Chiara Häfele ◽  
Sarah Glatter ◽  
Petra Trimmel-Schwahofer ◽  
Johann Golej ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Pediatric Intensive Care Unit ◽  
Ketogenic Diet ◽  
Pediatric Intensive Care ◽  
Refractory Status Epilepticus ◽  
Anesthetic Drugs ◽  
Refractory Status ◽  
Prospective Longitudinal

Background: To evaluate the use of the ketogenic diet (KD) for treatment of super-refractory status epilepticus (SRSE) at a pediatric intensive care unit (PICU).Design: A retrospective analysis of all pediatric patients treated for SRSE with the KD at our center was performed using patient data from our prospective longitudinal KD database.Setting: SRSE is defined as refractory SE that continues or recurs 24 h or more after initiation of anesthetic drugs. We describe the clinical and electroencephalographic (EEG) findings of all children treated with KD at our PICU. The KD was administered as add-on after failure of standard treatment. Response was defined as EEG seizure resolution (absence of seizures and suppression–burst ratio ≥50%).Patients: Eight consecutive SRSE patients (four females) treated with KD were included. Median age at onset of SRSE was 13.6 months (IQR 0.9–105), and median age at KD initiation was 13.7 months (IQR 1.9 months to 8.9 years). Etiology was known in 6/8 (75%): genetic in 4 (50%), structural in 1 (12.5%), and autoimmune/inflammatory in 1 (12.5%).Main Results: Time from onset of SRSE to initiation of KD was median 6 days (IQR 1.3–9). Time until clinically relevant ketosis (beta-hydroxybutyrate (BHB) >2 mmol/L in serum) was median 68.0 h (IQR 27.3–220.5). Higher ketosis was achieved when a higher proportion of enteral feeds was possible. Four (50%) patients responded to KD treatment within 7 days. During follow-up (median 4.2 months, IQR 1.6–12.3), 5/8 patients—three of them responders—died within 3–12 months after SRSE.Conclusions: In eight patients with SRSE due to severe etiologies including Alpers syndrome, we report an initial 50% response to KD. KD was used early in SRSE and sufficient levels of ketosis were reached early in most patients. Higher ketosis was achieved with combined enteral and parenteral feedings.

scholarly journals Ketogenic diet for super-refractory status epilepticus: A case series and review of literature

2021 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
VimalKumar Paliwal ◽  
Sucharita Anand ◽  
AmarS Vibhute ◽  
Ananya Das ◽  
Shilpi Pandey
Keyword(s):  
Status Epilepticus ◽  
Ketogenic Diet ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Review Of Literature ◽  
Refractory Status

scholarly journals Refractory Status Epilepticus: Experience in a Neurological Intensive Care Unit

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
O. H. Hernandez ◽  
J. F. Zapata ◽  
M. Jimenez ◽  
M. Massaro ◽  
A. Guerra ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Short Term ◽  
Neurological Intensive Care Unit ◽  
Term Outcome ◽  
Neurological Intensive Care ◽  
Refractory Status ◽  
Short Term Outcome

Introduction. Refractory status epilepticus (RSE) has significant morbidity and mortality, and its management requires an accurate diagnosis and aggressive treatment. Objectives. To describe the experience of management of RSE in a neurological intensive care unit (NeuroICU) and determine predictors of short-term clinical outcome. Methods. We reviewed cases of RSE from September 2007 to December 2008. Management was titrated to findings on continuous video EEG (cVEEG). We collected patients’ demographics, RSE etiology, characteristics of seizures, cVEEG findings, treatments, and short-term outcome. Control of RSE was to achieve burst suppression pattern or electrographic cessation of ictal activity. Results. We included 80 patients; 63.8% were in coma, 25% had subclinical seizures, and 11.3% had focal activity. 51.3% were male and mean age was 45 years. Etiology was neurological lesion in 75.1%, uncontrolled epilepsy in 20%, and systemic derangements in 4.9%. 78.8% were treated with general anesthesia and concomitant anticonvulsant drugs. The control of RSE was 87.5% of patients. In-hospital mortality was 22.5%. The factors associated with unfavorable short-term outcome were coma and age over 60 years. Conclusions. RSE management guided by cVEEG is associated with a good seizure control. A multidisciplinary approach can help achieve a better short-term functional outcome in noncomatose patients.

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