[P2-117] Ketogenic Diet in the Pediatric Intensive Care Unit for Super-Refractory Status Epilepticus: A clinic report
[Introduction] Super-refractory status epilepticus (SRSE) refers to status epilepticus that continues or recurs 24h or more after the onset of anesthetic therapy. SRSE is associated with high mortality and morbidity, and difficult for treatment. Ketogenic diet (KD) has reported success in leading to a better response. Here we reported a patient with SRSE in pediatric intensive care unit (PICU) successfully weaning off continuous anesthetic infusions after initial KD.
[Methodology] A 5-year old patient with SRSE in PICU was given initial KD after both antiepileptic drugs and anesthetic agent failed in seizure control. During KD therapy, daily metabolic panel, urine dipsticks and serum glucose were monitored. Data from his hospital course was supplemented by review of electronic medical record.
[Results] The pediatric patient had status epilepticus onset after a viral encephalitis attack. Clinical manifestation included decreased level of consciousness, partial onset seizures and generalized tonic-clonic seizure. Multiple white matter lesions scattered in frontal, occipital, temporal and periventricular area were identified on MRI. EEG showed unilateral or both sides sharp waves or spike in frontal and anterior temporal area. Four different first- and second-line antiepileptic drugs (AEDs) and continuous infusion of midazolam and propofol were trailed to control SE unsuccessfully. One week after initial KD, seizure control was variable, while patient were weaned off continuous anesthetic infusions successfully.
[Conclusions] In this study, the patient achieved resolution of SE on KD therapy, suggesting it could be an effective therapy, more studies are needed to determine effectiveness, safety, and tolerability of KD in the management of SRSE.
[Methodology] A 5-year old patient with SRSE in PICU was given initial KD after both antiepileptic drugs and anesthetic agent failed in seizure control. During KD therapy, daily metabolic panel, urine dipsticks and serum glucose were monitored. Data from his hospital course was supplemented by review of electronic medical record.
[Results] The pediatric patient had status epilepticus onset after a viral encephalitis attack. Clinical manifestation included decreased level of consciousness, partial onset seizures and generalized tonic-clonic seizure. Multiple white matter lesions scattered in frontal, occipital, temporal and periventricular area were identified on MRI. EEG showed unilateral or both sides sharp waves or spike in frontal and anterior temporal area. Four different first- and second-line antiepileptic drugs (AEDs) and continuous infusion of midazolam and propofol were trailed to control SE unsuccessfully. One week after initial KD, seizure control was variable, while patient were weaned off continuous anesthetic infusions successfully.
[Conclusions] In this study, the patient achieved resolution of SE on KD therapy, suggesting it could be an effective therapy, more studies are needed to determine effectiveness, safety, and tolerability of KD in the management of SRSE.