Ketogenic Diet for Adults in Super Refractory Status Epilepticus

In the January 22, 2014, issue of the journal Neurology, Drs. Thakur and colleagues from the Johns Hopkins Medical Center present an analysis that describes a series of adult patients in the intensive care unit who presented with super refractory status epilepticus (that is, status epilepticus that lasts 24 hours or more despite appropriate anesthetic treatment), then were treated with the ketogenic diet with the intention of stopping their emergency seizures. From a group of four medical centers of adult patients with status epilepticus,

• the researchers identified 10 adult patients who were treated with this diet.

• The median age of the patients was 33 years, four were male and seven had encephalitis.

• The duration of status before starting ketogenic diet was about 21 days, and the number of drugs tried before the diet was seven.

• The analysis showed that 90% of patients achieved ketosis, and status epilepticus ceased in all patients achieving ketosis within three days.

  • Three patients had minor complications of transient acidosis and hypertriglyceridemia.

  • Two patients died of causes unrelated to ketogenic diet.

The authors concluded that treatment of critically ill patients with status epilepticus with ketogenic diet can achieve resolution and that prospective trials are needed.