Efficacy and safety of ketogenic diet for treatment of pediatric convulsive refractory status epilepticus

•KD achieved EEG seizure resolution in 71% of patients with RSE within 7 days.•79% of RSE patients could be weaned off their infusion treatments within 14 days.•KD is under-utilized (only 7% of patients from 11 centers) for treatment of RSE.•KD is used late (median 13 days after onset) for the treat...

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Bibliographic Details
Published in:Epilepsy research 2018-08, Vol.144, p.1-6
Main Authors: Arya, Ravindra, Peariso, Katrina, Gaínza-Lein, Marina, Harvey, Jessica, Bergin, Ann, Brenton, J. Nicholas, Burrows, Brian T., Glauser, Tracy, Goodkin, Howard P., Lai, Yi-Chen, Mikati, Mohamad A., Fernández, Iván Sánchez, Tchapyjnikov, Dmitry, Wilfong, Angus A., Williams, Korwyn, Loddenkemper, Tobias
Format: Article
Language:English
Subjects:
Adolescent
Child
Child, Preschool
Cohort Studies
Continuous infusions
Diet, Ketogenic - methods
Drug Resistant Epilepsy - diet therapy
Electroencephalography
Electrographic seizure resolution
Female
Humans
Infant
Male
Multi-center cohort
Status Epilepticus - diet therapy
Suppression burst ratio
Treatment Outcome
Young Adult
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Summary:•KD achieved EEG seizure resolution in 71% of patients with RSE within 7 days.•79% of RSE patients could be weaned off their infusion treatments within 14 days.•KD is under-utilized (only 7% of patients from 11 centers) for treatment of RSE.•KD is used late (median 13 days after onset) for the treatment of RSE. To describe the efficacy and safety of ketogenic diet (KD) for convulsive refractory status epilepticus (RSE). RSE patients treated with KD at the 6/11 participating institutions of the pediatric Status Epilepticus Research Group from January-2011 to December-2016 were included. Patients receiving KD prior to the index RSE episode were excluded. RSE was defined as failure of ≥2 anti-seizure medications, including at least one non-benzodiazepine drug. Ketosis was defined as serum beta-hydroxybutyrate levels >20 mg/dl (1.9 mmol/l). Outcomes included proportion of patients with electrographic (EEG) seizure resolution within 7 days of starting KD, defined as absence of seizures and ≥50% suppression below 10 μV on longitudinal bipolar montage (suppression-burst ratio ≥50%); time to start KD after onset of RSE; time to achieve ketosis after starting KD; and the proportion of patients weaned off continuous infusions 2 weeks after KD initiation. Treatment-emergent adverse effects (TEAEs) were also recorded. Fourteen patients received KD for treatment of RSE (median age 4.7 years, interquartile range [IQR] 5.6). KD was started via enteral route in 11/14 (78.6%) patients. KD was initiated a median of 13 days (IQR 12.5) after the onset of RSE, at 4:1 ratio in 8/14 (57.1%) patients. Ketosis was achieved within a median of 2 days (IQR 2.0) after starting KD. EEG seizure resolution was achieved within 7 days of starting KD in 10/14 (71.4%) patients. Also, 11/14 (78.6%) patients were weaned off their continuous infusions within 2 weeks of starting KD. TEAEs, potentially attributable to KD, occurred in 3/14 (21.4%) patients, including gastro-intestinal paresis and hypertriglyceridemia. Three month outcomes were available for 12/14 (85.7%) patients, with 4 patients being seizure-free, and 3 others with decreased seizure frequency compared to pre-RSE baseline. This series suggests efficacy and safety of KD for treatment of pediatric RSE.
ISSN:0920-1211
1872-6844
DOI:10.1016/j.eplepsyres.2018.04.012