Could the Ketogenic Diet Treat Refractory Status Epilepticus?
Patients with refractory status epilepticus (RSE) may benefit from the ketogenic diet (KD), according to a recent review. However strong evidence supporting this treatment option is lacking.
For their literature review, the researchers identified 17 studies that examined the efficacy of KD and included a total of 84 patients. The majority of patients were children (median age 10 years) and 26% had a history of epilepsy prior to presentation. In addition, the predominate clinical presentations for RSE were associated with encephalitis (32%) and febrile infection-related epilepsy syndrome (26%).
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The researchers found that the KD resolved RSE symptoms among 71 out of 84 patients (85%) with a median time to resolution after initiating the diet of 5 days. Adverse effects were observed in 35% of patients, which included hypertriglyceridemia, constipation, hypoglycemia, and acidosis.
In addition, 3 patients died of other complications after the resolution of RSE. Thirteen patients continued to have uncontrolled RSE that required additional treatment, of whom 5 died.
“Mortality was significantly lower in the reviewed studies than previous reported, which may reflect bias in patient selection. Although traditionally KD is used for outpatients as treatment for chronic drug-resistant epilepsy, consideration should be made for use in the acute setting,” the researchers concluded. “Monitoring of the diet is crucial to limit the risk of side-effects.”
“A robust randomized-controlled trial is required to evaluate the efficacy of KD for RSE, but the emerging number of publications with lower level evidence provides promising data that KD may be a safe and effective treatment for RSE.”
—Melissa Weiss
Reference:
Kaul N, Nation J, Kwan P, O’Brien TJ. Is the keogenic diet a safe and tolerable treatment for refractory status epilepticus? A systematic review. Presented at: American Epilepsy Society Annual Meeting; December 1-5, 2017; Washington, DC. Abstract 3.336.