Ketogenic Diet as a Therapeutic Option in Super-refractory Status Epilepticus

Abstract

Super-refractory status epilepticus (SRSE) is defined as status epilepticus (SE) that continues or recurs 24 hours or more after the onset of anesthetic therapy and constitutes up to 15% of all SE admissions. One underpowered randomized controlled study has compared barbiturate treatment and propofol treatment for SRSE. Limited additional information on potential treatments for SRSE comes from single case reports and small case series. A ketogenic diet (KD) has an antiepileptic effect and is suggested as a treatment option for refractory epilepsy in children and young adults. KD is generally well tolerated and side effects are relatively mild. However, the lack of robust data, together with limited clinical experience, has limited the use of KD in SRSE. In addition, SRSE is a heterogeneous group of conditions with variable etiology, course, and prognosis. It is recognized that conducting adequate trials to support the efficacy of KD in SRSE will be difficult. Shorvon and Ferlisi reviewed available therapies for SRSE and suggested that KD should probably be tried in all severe cases. Successful implementation of KD requires the collaboration and communication between neurologists, intensivists, dietitians, and nursing staff. Health care professionals using KD need to know the principles and