The Ketogenic Diet as Broad-Spectrum Treatment for Super-Refractory Pediatric Status Epilepticus

Cobo, Nicole H.; Sankar, Raman; Murata, Kristina K.; Sewak, Sarika; Kezele, Michele A.; Matsumoto, Joyce H.

doi:10.1177/0883073813516192

Cited by 52 publications

(31 citation statements)

References 25 publications

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“…Relatively low rates of adverse effects were noted, but these included gastrointestinal disturbances, electrolyte imbalance, and ketoacidosis, with the main causes of discontinuation being pancreatitis and hypertriglyceridemia [38,39]. These outcomes are consistent with those of other studies with fewer than 10 patients [41][42][43][44][45][46][47][48][49], and patients with FIRES have also been found to respond quickly after KDT initiation [40,46,47]. Most patients are good responders, weaning off infusion and successfully reaching ketosis, but the number of AEDs did not change significantly before and after undertaking a KDT [40,43].…”

Section: The Gut-brain Axis and Kdtssupporting

confidence: 82%

“…Most patients are good responders, weaning off infusion and successfully reaching ketosis, but the number of AEDs did not change significantly before and after undertaking a KDT [40,43]. The age of patients has varied across studies, but even 6 to 10-week-old neonates with RE are reported to tolerate KDTs well [42,50]. Intravenous (IV) KDT is recommended for patients with underlying concomitant ileus [41,44,48], and early administration of IV KDT should be considered before switching to an enteral route [44].…”

Section: The Gut-brain Axis and Kdtsmentioning

confidence: 98%

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Advances in Ketogenic Diet Therapies in Pediatric Epilepsy

2019

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Ketogenic diets are high in fat, low in carbohydrates, and contain an adequate amount of protein. In addition to the classic ketogenic diet, three alternative types of ketogenic diet therapies (KDTs) have emerged. In addition to clarifying the indications for early treatment using KDTs, ongoing research over the past decades has led to the recognition of their contraindications and adverse effects. Recent studies focusing on the targeted therapeutic range of KDTs are expected to elucidate the precise mechanisms by which they alleviate certain epilepsy syndromes and other disorders. In this review, we discuss recent advances in KDTs, focusing on six issues: the selection of a specific KDT; the use of KDTs for febrile infection-related epilepsy syndrome and super-refractory status epilepticus; the use of KDTs for infants with refractory epilepsy; links between the gut-brain axis and KDTs; triheptanoin; and the use of KDTs for disorders other than pediatric epilepsy.

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Section: The Gut-brain Axis and Kdtssupporting

confidence: 82%

Section: The Gut-brain Axis and Kdtsmentioning

confidence: 98%

Advances in Ketogenic Diet Therapies in Pediatric Epilepsy

2019

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“…Recent observations in patients with FIRES or other causes of RSE support the use, in the ICU, of less-conventional therapeutic options with suspected anti-inflammatory properties, such as the ketogenic diet (KD) or hypothermia [98][99][100]. Whether these mechanisms explain the favorable outcome of certain patients with FIRES remains to be demonstrated formally.…”

Section: Autoimmunity and Inflammation In Status Epilepticusmentioning

confidence: 95%

Autoimmunity and inflammation in status epilepticus: from concepts to therapies

Holzer

Seeck

Korff³

2014

Expert Review of Neurotherapeutics

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The understanding of immunological mechanisms underlying some forms of epilepsy and encephalitis has rapidly increased for the last 10 years leading to the concept of status epilepticus of autoimmune origin. Actual treatment recommendations regarding autoimmune status epilepticus are based on retrospective case studies, pathophysiological considerations and experts' opinion. In addition, there are no clear indicators to predict outcome. In situations where autoimmune mechanisms are suspected in patients with status epilepticus, there is evidence that earlier treatment is related to better outcome. Increased awareness is mandatory to decrease the number of patients with major neurological problems or fatal outcome, which is overall about 50%. We here summarize findings of all pediatric and adult patients reported to date, and review the current state of knowledge in the field of immune therapeutic approaches of status epilepticus.

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“…In patients with refractory LGS (2) Anoxic brain injury (2) epilepsy, KD is generally well tolerated with reported adverse effects such as gastrointestinal symptoms, metabolic acidosis, nephrolithiasis, and increased propensity to infections. 37 Five of the studies used in this review reported adverse effects from KD. 4,[15][16][17]34 The most common adverse effects reported in the reviewed studies were metabolic acidosis, hyperlipidemia, and hypoglycemia.…”

Section: Safety Of Kd In Adults With Sementioning

confidence: 99%

Systematic review of ketogenic diet use in adult patients with status epilepticus

2019

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Status epilepticus (SE) is a medical emergency that is associated with a significant morbidity and mortality. Recently, there has been significant interest in the use of ketogenic diets (KD) in the management of SE. KD is a high‐fat, low‐carbohydrate, and adequate protein diet that has been shown to be a safe and effective adjuvant to present SE management in patients with refractory epilepsy. Many case reports and case series have demonstrated the potential safety and effectiveness of KD for the acute treatment of SE; however, quality studies remain scarce on this topic. The purpose of this systematic review is to summarize the available evidence for the safety and effectiveness of KD in adults with SE. A literature search was performed in MEDLINE, EMBASE, Cochrane Library, and CINAHL (September 14, 2018). The search was repeated on March 27, 2019, to include any studies published since the original search. Keywords related to KD and SE were used. Studies were selected based on the reported use of the KD in SE. The search resulted in a total of 954 records. After screening and full‐text review, 17 articles were included in this review: four observational studies, 10 case reports, and 3 case series. Based on the observational studies, a total of 38 Patients with SE have been reported. KD was successful in achieving cessation of SE in 31 Patients (82%). The most common adverse effects reported were metabolic acidosis, hyperlipidemia, and hypoglycemia. The current limited evidence suggests that KD might be considered as an option for adult patients with SE. Although promising, the results need to be interpreted with caution due to the inherent bias, confounding and small sample size of the included studies. A randomized controlled trial is recommended to establish role of KD in the management of SE in adults.

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The Ketogenic Diet as Broad-Spectrum Treatment for Super-Refractory Pediatric Status Epilepticus

Cited by 52 publications

References 25 publications

Advances in Ketogenic Diet Therapies in Pediatric Epilepsy

Advances in Ketogenic Diet Therapies in Pediatric Epilepsy

Autoimmunity and inflammation in status epilepticus: from concepts to therapies

Systematic review of ketogenic diet use in adult patients with status epilepticus

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