[P2-115] The ketogenic diet for super-refractory status epilepticus in the intensive care unit
Objectives: Super-refractory status epilepticus (SE) is one of the most challenging issues in epilepsy in that it is associated with high morbidity and mortality. In this study, we evaluated the efficacy and safety of Ketogenic diet (KD) to provide clinical guidelines and recommendations for the management of super-refractory SE in intensive care unit (ICU).
Materials and methods: We retrospectively reviewed the medical records of 20 patients (16 children, 4 adults) with super-refractory SE who were treated with KD in the ICU at Samsung Medical Center from July 2005 to February 2016.
Results: Of the 20 patients, 16 patients were clinically diagnosed with viral meningoencephalitis and viruses were detected in cerebrospinal fluid of 4 patients. Four patients had hypoxic ischemic encephalopathy, focal cortical dysplasia, and cryptogenic epilepsy, respectively. The median interval between the onset of SE and KD was 22.5 days (range, 2 – 420). The KD was maintained for a median of 1.35 months (range, 0.1 – 18.5). Among the 12 patients who were on continuous midazolam or pentobarbital infusion, 8 patients were successfully weaned off anesthetic agents after KD. At discharge, 9 patients became seizure-free, 8 patients showed >50% seizure reduction, and the other 3 patients had <50% decrease in seizure frequency. The KD was discontinued by 8 patients because of adverse effects, such as nausea, vomiting, aspiration pneumonia, nephrolithiasis, hypokalemia, and hypoalbuminemia.
Conclusion: The KD may be an alternative strategy to safely and effectively treat super- refractory SE in that it helps lowering seizure frequency and reducing medication burden. Close monitoring and preventive management of potential adverse effects is a key to successful treatment outcomes with KD super-refractory SE.
Materials and methods: We retrospectively reviewed the medical records of 20 patients (16 children, 4 adults) with super-refractory SE who were treated with KD in the ICU at Samsung Medical Center from July 2005 to February 2016.
Results: Of the 20 patients, 16 patients were clinically diagnosed with viral meningoencephalitis and viruses were detected in cerebrospinal fluid of 4 patients. Four patients had hypoxic ischemic encephalopathy, focal cortical dysplasia, and cryptogenic epilepsy, respectively. The median interval between the onset of SE and KD was 22.5 days (range, 2 – 420). The KD was maintained for a median of 1.35 months (range, 0.1 – 18.5). Among the 12 patients who were on continuous midazolam or pentobarbital infusion, 8 patients were successfully weaned off anesthetic agents after KD. At discharge, 9 patients became seizure-free, 8 patients showed >50% seizure reduction, and the other 3 patients had <50% decrease in seizure frequency. The KD was discontinued by 8 patients because of adverse effects, such as nausea, vomiting, aspiration pneumonia, nephrolithiasis, hypokalemia, and hypoalbuminemia.
Conclusion: The KD may be an alternative strategy to safely and effectively treat super- refractory SE in that it helps lowering seizure frequency and reducing medication burden. Close monitoring and preventive management of potential adverse effects is a key to successful treatment outcomes with KD super-refractory SE.