Phase I/II multicenter ketogenic diet study for adult superrefractory status epilepticus.
Cervenka, Mackenzie C. MD; Hocker, Sara MD; Koenig, Matthew MD; Bar, Barak MD; Henry-Barron, Bobbie RD; Kossoff, Eric H. MD; Hartman, Adam L. MD; Probasco, John C. MD; Benavides, David R. MD, PhD; Venkatesan, Arun MD, PhD; Hagen, Eliza C. MD, MBA; Dittrich, Denise RN; Stern, Tracy RN; Radzik, Batya CRNP; Depew, Marie ACNP; Caserta, Filissa M. MSN, ACNP-BC, CNRN; Nyquist, Paul MD, MPH; Kaplan, Peter W. MB, FRCP; Geocadin, Romergryko G. MD
[Article]
Neurology.
88(10):938-943, March 07, 2017.
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Objective: To investigate the feasibility, safety, and efficacy of a ketogenic diet (KD) for superrefractory status epilepticus (SRSE) in adults.
Methods: We performed a prospective multicenter study of patients 18 to 80 years of age with SRSE treated with a KD treatment algorithm. The primary outcome measure was significant urine and serum ketone body production as a biomarker of feasibility. Secondary measures included resolution of SRSE, disposition at discharge, KD-related side effects, and long-term outcomes.
Results: Twenty-four adults were screened for participation at 5 medical centers, and 15 were enrolled and treated with a classic KD via gastrostomy tube for SRSE. Median age was 47 years (interquartile range [IQR] 30 years), and 5 (33%) were male. Median number of antiseizure drugs used before KD was 8 (IQR 7), and median duration of SRSE before KD initiation was 10 days (IQR 7 days). KD treatment delays resulted from intravenous propofol use, ileus, and initial care received at a nonparticipating center. All patients achieved ketosis in a median of 2 days (IQR 1 day) on KD. Fourteen patients completed KD treatment, and SRSE resolved in 11 (79%; 73% of all patients enrolled). Side effects included metabolic acidosis, hyperlipidemia, constipation, hypoglycemia, hyponatremia, and weight loss. Five patients (33%) ultimately died.
Conclusions: KD is feasible in adults with SRSE and may be safe and effective. Comparative safety and efficacy must be established with randomized placebo-controlled trials.
Classification of evidence: This study provides Class IV evidence that in adults with SRSE, a KD is effective in inducing ketosis.
(C) 2017 American Academy of Neurology