The ketogenic diet as broad-spectrum treatment for super-refractory pediatric status epilepticus: challenges in implementation in the pediatric and neonatal intensive care units.
Refractory status epilepticus carries significant morbidity and mortality. Recent reports have promoted the use of the ketogenic diet as an effective treatment for refractory status epilepticus. We describe our recent experience with instituting the ketogenic diet for 4 critically ill children in refractory status epilepticus, ranging in age from 9 weeks to 13.5 years after failure of traditional treatment. The ketogenic diet allowed these patients to be weaned off continuous infusions of anesthetics without recurrence of status epilepticus, though delayed ketosis and persistently elevated glucose measurements posed special challenges to effective initiation, and none experienced complete seizure cessation. The ease of sustaining myocardial function with fatty acid energy substrates compares favorably over the myocardial toxicity posed by anesthetic doses of barbiturates and contributes to the safety profile of the ketogenic diet. The ketogenic diet can be implemented successfully and safely for the treatment of refractory status epilepticus in pediatric patients.
Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA ncobo@mednet.ucla.edu.
Nicole H
NH
Cobo
Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA Department of Neurology, David Geffen School of Medicine, University of California Los Angeles and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA.
Raman
R
Sankar
Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA.
Kristina K
KK
Murata
Department of Nutrition, Mattel Children's Hospital at UCLA, Los Angeles, CA, USA.
Sarika L
SL
Sewak
Department of Nutrition, Mattel Children's Hospital at UCLA, Los Angeles, CA, USA.
Michele A
MA
Kezele
Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA.
Joyce H
JH
Matsumoto
D020155:3-Hydroxybutyric Acid / Q000097:blood; D000293:Adolescent; D001786:Blood Glucose; D002648:Child; D055423:Diet, Ketogenic / Q000379:methods*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D013226:Status Epilepticus / Q000097:blood / Q000178:diet therapy*; D016896:Treatment Outcome
D001786:Blood Glucose; D020155:3-Hydroxybutyric Acid
children; ketogenic diet; pediatric; refractory; seizures; status epilepticus