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.
journal_name
Neurologyjournal_title
Neurologyauthors
Cervenka MC,Hocker S,Koenig M,Bar B,Henry-Barron B,Kossoff EH,Hartman AL,Probasco JC,Benavides DR,Venkatesan A,Hagen EC,Dittrich D,Stern T,Radzik B,Depew M,Caserta FM,Nyquist P,Kaplan PW,Geocadin RGdoi
10.1212/WNL.0000000000003690subject
Has Abstractpub_date
2017-03-07 00:00:00pages
938-943issue
10eissn
0028-3878issn
1526-632Xpii
WNL.0000000000003690journal_volume
88pub_type
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