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

Super-refractory status epilepticus (SRSE) represents a neurological emergency that is characterized by a lack of response to the third line of antiepileptic treatment, including intravenous general anesthetics. It is a medical challenge with high morbidity and mortality. Electroconvulsive therapy (ECT) has been recommended as a nonpharmacologic option of treatment after other alternatives are unsuccessful. Its effect on the cessation of SRSE has been minimally investigated. The objective of this article is to analyze the effect of ECT on SRSE. For this purpose, a multidisciplinary team created a protocol based on clinical guidelines similar to those described previously by Ray et al. (2017). ECT was applied to six patients with SRSE after the failure of antiepileptic treatment and pharmacologic coma.The objective of each ECT session was to elicit a motor seizure for at least 20 s. SRSE was resolved in all patients after several days of treatment, including ECT as a therapy, without relevant adverse effects. Thus, ECT is an effective and feasible option in the treatment of SRSE, and its place in the algorithm in treatment should be studied due to the uncommon adverse effects and the noninvasive character of the therapy.

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Ketogenic Diet in Status Epilepticus

10.1093/med/9780190497996.003.0009 ◽

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.

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Intravenous Ketogenic Diet Therapy for Treatment of the Acute Stage of Super-Refractory Status Epilepticus in a Pediatric Patient

Pediatric Neurology ◽

10.1016/j.pediatrneurol.2014.12.008 ◽

2015 ◽

Vol 52 (4) ◽

pp. 442-445 ◽

Cited By ~ 19

Author(s):

Jainn-Jim Lin ◽

Kuang-Lin Lin ◽

Oi-Wa Chan ◽

Shao-Hsuan Hsia ◽

Huei-Shyong Wang

Keyword(s):

Status Epilepticus ◽

Pediatric Patient ◽

Ketogenic Diet ◽

Diet Therapy ◽

Refractory Status Epilepticus ◽

Acute Stage ◽

Refractory Status

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Combination of ketogenic diet and stiripentol for super-refractory status epilepticus: A case report

Journal of the Neurological Sciences ◽

10.1016/j.jns.2016.12.020 ◽

2017 ◽

Vol 373 ◽

pp. 35-37 ◽

Cited By ~ 8

Author(s):

Yuto Uchida ◽

Daisuke Kato ◽

Takanari Toyoda ◽

Masahiro Oomura ◽

Yoshino Ueki ◽

...

Keyword(s):

Case Report ◽

Status Epilepticus ◽

Ketogenic Diet ◽

Refractory Status Epilepticus ◽

Refractory Status

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The Treatment and Prognosis of Refractory and Super-Refractory Status Epilepticus

Neurology International Open ◽

10.1055/s-0043-110165 ◽

2017 ◽

Vol 01 (03) ◽

pp. E204-E210

Author(s):

Stephanie Gollwitzer ◽

Hajo Hamer

Keyword(s):

Status Epilepticus ◽

Electroconvulsive Therapy ◽

Case Reports ◽

Case Series ◽

Refractory Status Epilepticus ◽

Evidence Based ◽

New Approach ◽

Refractory Status ◽

First Choice ◽

Evidence Based Guidelines

AbstractRefractory status epilepticus (RSE) is defined as status epilepticus (SE) persisting over 60 min and resistant to treatment with benzodiazepines and non-sedating antiepileptic drugs. The term super-refractory status epilepticus (SRSE) refers to a refractory episode continuing under general anesthesia for more than 24 h. RSE is treated with a combination of non-sedating AED and i. v. anesthetics; first choice drugs are midazolam, propofol and thiopental. The management of super-refractory status epilepticus (SRSE) is challenging as clear evidence-based guidelines are lacking. Recommendations are mainly based on case reports and small case series. Therapeutic options include ketamine, inhalational anesthetics, steroids and immunoglobulins. Ketogenic diet, electroconvulsive therapy and epilepsy surgery are also considered as potentially effective. A promising new approach is the neurosteroid allopregnanolone. Mortality of RSE and SRSE is largely influenced by the etiology and is markedly higher as compared to non-refractory status epilepticus. It was reported to be about 30% and 50%, respectively.

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The ketogenic diet for super-refractory status epilepticus patients in intensive care units

Brain and Development ◽

10.1016/j.braindev.2018.12.007 ◽

2019 ◽

Vol 41 (5) ◽

pp. 420-427 ◽

Cited By ~ 13

Author(s):

Eu Gene Park ◽

Jiwon Lee ◽

Jeehun Lee

Keyword(s):

Intensive Care ◽

Status Epilepticus ◽

Intensive Care Units ◽

Ketogenic Diet ◽

Refractory Status Epilepticus ◽

Refractory Status

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Super-Refractory Status Epilepticus Treated with High Dose Perampanel: Case Series and Review of the Literature

Case Reports in Critical Care ◽

10.1155/2019/3218231 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Christopher R. Newey ◽

Naresh Mullaguri ◽

Stephen Hantus ◽

Vineet Punia ◽

Pravin George

Keyword(s):

Cardiac Arrest ◽

Status Epilepticus ◽

Case Series ◽

Refractory Status Epilepticus ◽

Critically Ill Patient ◽

Unknown Etiology ◽

High Dose ◽

The Novel ◽

Refractory Status ◽

Symptomatic Seizures

Introduction. Acute symptomatic seizures are frequent in the critically ill patient and can be difficult to treat. The novel anticonvulsant perampanel may be effective in the treatment of status epilepticus considering its mechanism of action of being an AMPA antagonist. We present four cases of super refractory status epilepticus treated with high dose perampanel. Method. Case report. Cases. Four patients were treated with perampanel for their refractory status epilepticus. One patient had new onset refractory status epilepticus of unknown etiology. Three other patients had status epilepticus as a result of their cardiac arrest. Two of the cardiac arrest patients had myoclonus. In all patients, the additional of perampanel resulted in a reduction of seizure burden without affecting hemodynamics or hepatic or renal function. Conclusion. Perampanel may be effective in the treatment of super-refractory status epilepticus of varying etiologies. A larger, prospective study is needed to further assess this therapy.

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