The Efficacy, Safety and Side-Effect Profile of the Ketogenic Diet in the Treatment of Pediatric Super-Refractory Status Epilepticus

Introduction: To assess patients with super-refractory status epilepticus and treated with the ketogenic diet in the pediatric intensive care unit. Materials and methods: Six patients with super-refractory status epilepticus in the pediatric intensive care unit of Cengiz Gökçek Children's Hospital were evaluated retrospectively. Demographic characteristics, antiepileptics used, time of start and duration of ketogenic diet, and the efficacy of the diet and its side-effects were evaluated. Results: Four of the six patients (66.6%) were female. Patients’ mean age was 2.8 years (min: 1, max: 9 years). Four epileptic encephalopathies were determined, two Lennox-Gastaut, one WWOX encephalopathy, and one undiagnosed epileptic encephalopathy. Mean time from the start of status epilepticus to start of ketogenic diet was 13.1 days (min: 8, max: 20) and mean duration of the ketogenic diet was 4.1 months (min: 1, max: 8). One patient's seizures ceased, and the seizures of two other patients decreased by more than 50%. One patient died from complications not associated with the ketogenic diet. Conclusion: In this retrospective study of the efficacy of the ketogenic diet in the treatment of super-refractory epilepticus, decreases in seizure numbers of at least 50% were achieved in 50% of patients. No life-threatening complications occurred. Multi-centered, prospective studies with larger patient number will shed further light on this subject.