Application of ketogenic diets for pediatric neurocritical care

Abstract

In this review, we summarize the general mechanisms of the ketogenic diet, and the application of a ketogenic diet in pediatric intensive care units for the neurological disorders of children and young infants. A ketogenic diet is a high-fat, low-carbohydrate, adequate-protein diet. It can alter the primary cerebral energy metabolism from glucose to ketone bodies, which involves multiple mechanisms of antiepileptic action, antiepileptogenic properties, neuro-protection, antioxidant and anti-inflammatory effects, and it is potentially a disease-modifying intervention. Although a ketogenic diet is typically used for the chronic stage of pharmacoresistant of epilepsy, recent studies have shown its efficacy in patients with the acute stage of refractory/super-refractory status epilepticus. The application of a ketogenic diet in pediatric intensive care units is a challenge because of the critical status of the patients, who are often in a coma or have a nothing by mouth order. Moreover, a ketogenic diet needs to be started early and sometimes through parenteral administration in patients with critical conditions such as refractory status epilepticus or febrile infection-related epilepsy syndrome. Animal models and some case reports have shown that the neuro-protective effects of a ketogenic diet can be extended to other emergent neurological diseases, such as traumatic brain injury and ischemic stroke.

Evaluation of E-Health Applications for Paediatric Patients with Refractory Epilepsy and Maintained on Ketogenic Diet

“…The application of a ketogenic diet is suitable for children and young infants in paediatric intensive care units for neurological disorders. Indeed, it is mainly used in cases of chronic refractoriness to antiepileptic drugs, but it is also a therapeutic option for the acute stage of refractory/super-refractory status epilepticus [ 25 ]. The use of this dietary treatment is challenging because of the critical status of the patients [ 25 ] and the low variability, palatability, and tolerability of the diet itself [ 19 ].…”

“…Indeed, it is mainly used in cases of chronic refractoriness to antiepileptic drugs, but it is also a therapeutic option for the acute stage of refractory/super-refractory status epilepticus [ 25 ]. The use of this dietary treatment is challenging because of the critical status of the patients [ 25 ] and the low variability, palatability, and tolerability of the diet itself [ 19 ]. Furthermore, a ketogenic diet should be started as soon as possible, and an optimal management of the paediatric patients receiving this dietary therapy is required from the beginning [ 26 ].…”

Clinical application of target temperature management in children with acute encephalopathy–A practical review

“…The ketogenic diet was started and seizures were controlled within 48 h of institution of the ketogenic diet [ 25 ]. Because both of therapeutic hypothermia and a ketogenic diet have multiple neuroprotective mechanism, it is reasonable that concurrent therapeutic hypothermia and a ketogenic diet may be considered for treating refractory status epilepticus in children [ 28 ]. Because of various etiologies and no standard protocol in these case reports, it is difficult to summarize the best temperature and duration of TTM in pediatric refractory status epilepticus.…”

Protecting the blossoming brain – Neurocritical care in children

“…Here, Lin et al. review the state of the art regarding the application of ketogenic diets for paediatric neurocritical care, and argue that its use has great potential to be extended for a broader spectrum of cases [ 6 ].…”