The ketogenic diet as broad-spectrum treatment for super-refractory pediatric status epilepticus: challenges in implementation in the pediatric and neonatal intensive care units

Nicole H Cobo; Raman Sankar; Kristina K Murata; Sarika L Sewak; Michele A Kezele; Joyce H Matsumoto

doi:10.1177/0883073813516192

The ketogenic diet as broad-spectrum treatment for super-refractory pediatric status epilepticus: challenges in implementation in the pediatric and neonatal intensive care units

J Child Neurol. 2015 Feb;30(2):259-66. doi: 10.1177/0883073813516192. Epub 2014 Jan 23.

Authors

Nicole H Cobo¹, Raman Sankar², Kristina K Murata³, Sarika L Sewak⁴, Michele A Kezele⁴, Joyce H Matsumoto³

Affiliations

¹ Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA ncobo@mednet.ucla.edu.
² Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA Department of Neurology, David Geffen School of Medicine, University of California Los Angeles and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA.
³ Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles and Mattel Children's Hospital at UCLA, Los Angeles, CA, USA.
⁴ Department of Nutrition, Mattel Children's Hospital at UCLA, Los Angeles, CA, USA.

PMID: 24464515
DOI: 10.1177/0883073813516192

Abstract

Refractory status epilepticus carries significant morbidity and mortality. Recent reports have promoted the use of the ketogenic diet as an effective treatment for refractory status epilepticus. We describe our recent experience with instituting the ketogenic diet for 4 critically ill children in refractory status epilepticus, ranging in age from 9 weeks to 13.5 years after failure of traditional treatment. The ketogenic diet allowed these patients to be weaned off continuous infusions of anesthetics without recurrence of status epilepticus, though delayed ketosis and persistently elevated glucose measurements posed special challenges to effective initiation, and none experienced complete seizure cessation. The ease of sustaining myocardial function with fatty acid energy substrates compares favorably over the myocardial toxicity posed by anesthetic doses of barbiturates and contributes to the safety profile of the ketogenic diet. The ketogenic diet can be implemented successfully and safely for the treatment of refractory status epilepticus in pediatric patients.

Keywords: children; ketogenic diet; pediatric; refractory; seizures; status epilepticus.

Publication types

Case Reports

MeSH terms

3-Hydroxybutyric Acid / blood
Adolescent
Blood Glucose
Child
Diet, Ketogenic / methods*
Electroencephalography
Female
Humans
Intensive Care Units, Pediatric
Male
Status Epilepticus / blood
Status Epilepticus / diet therapy*
Treatment Outcome

Substances

Blood Glucose
3-Hydroxybutyric Acid