Ketogenic diet for adults in super-refractory status epilepticus.
OBJECTIVE
To describe a case series of adult patients in the intensive care unit in super-refractory status epilepticus (SRSE; refractory status lasting 24 hours or more despite appropriate anesthetic treatment) who received treatment with the ketogenic diet (KD).


METHODS
We performed a retrospective case review at 4 medical centers of adult patients with SRSE treated with the KD. Data collected included demographic features, clinical presentation, diagnosis, EEG data, anticonvulsant treatment, and timing and duration of the KD. Primary outcome measures were resolution of status epilepticus (SE) after initiation of KD and ability to wean from anesthetic agents.


RESULTS
Ten adult patients at 4 medical centers were started on the KD for SRSE. The median age was 33 years (interquartile range [IQR] 21), 4 patients (40%) were male, and 7 (70%) had encephalitis. The median duration of SE before initiation of KD was 21.5 days (IQR 28) and the median number of antiepileptic medications used before initiation of KD was 7 (IQR 7). Ninety percent of patients achieved ketosis, and SE ceased in all patients achieving ketosis in a median of 3 days (IQR 8). Three patients had minor complications of the KD including transient acidosis and hypertriglyceridemia and 2 patients ultimately died of causes unrelated to the KD.


CONCLUSIONS
We describe treatment of critically ill adult patients with SRSE with the KD, with 90% of patients achieving resolution of SE. Prospective trials are warranted to examine the efficacy of the KD in adults with refractory SE.


METHODS
This study provides Class IV evidence that for intensive care unit patients with refractory SE, a KD leads to resolution of the SE.
From the Departments of Neurology (K.T.T., J.C.P., E.H.K., R.G.G., A.L.H., A.V., M.C.C.) and Pediatrics (E.H.K., A.L.H.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (S.E.H.), Mayo Clinic, Rochester, MN; Department of Food and Nutrition Services (K.R.), Rush University Medical Center, Chicago, IL; Institute for Clinical and Translational Research (B.H.), Johns Hopkins University, Baltimore; Department of Neurology (P.W.K.), Johns Hopkins Bayview Medical Center, Baltimore; and Departments of Anesthesiology-Critical Care Medicine, Neurosurgery, and Medicine (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD.
Kiran T
KT
Thakur
John C
JC
Probasco
Sara E
SE
Hocker
Kelly
K
Roehl
Bobbie
B
Henry
Eric H
EH
Kossoff
Peter W
PW
Kaplan
Romergryko G
RG
Geocadin
Adam L
AL
Hartman
Arun
A
Venkatesan
Mackenzie C
MC
Cervenka
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D016638:Critical Illness; D055423:Diet, Ketogenic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000178:diet therapy* / Q000188:drug therapy; D016896:Treatment Outcome; D055815:Young Adult
D000927:Anticonvulsants