Systematic review of ketogenic diet use in adult patients with status epilepticus

Abstract

Status epilepticus (SE) is a medical emergency that is associated with a significant morbidity and mortality. Recently, there has been significant interest in the use of ketogenic diets (KD) in the management of SE. KD is a high‐fat, low‐carbohydrate, and adequate protein diet that has been shown to be a safe and effective adjuvant to present SE management in patients with refractory epilepsy. Many case reports and case series have demonstrated the potential safety and effectiveness of KD for the acute treatment of SE; however, quality studies remain scarce on this topic. The purpose of this systematic review is to summarize the available evidence for the safety and effectiveness of KD in adults with SE. A literature search was performed in MEDLINE, EMBASE, Cochrane Library, and CINAHL (September 14, 2018). The search was repeated on March 27, 2019, to include any studies published since the original search. Keywords related to KD and SE were used. Studies were selected based on the reported use of the KD in SE. The search resulted in a total of 954 records. After screening and full‐text review, 17 articles were included in this review: four observational studies, 10 case reports, and 3 case series. Based on the observational studies, a total of 38 Patients with SE have been reported. KD was successful in achieving cessation of SE in 31 Patients (82%). The most common adverse effects reported were metabolic acidosis, hyperlipidemia, and hypoglycemia. The current limited evidence suggests that KD might be considered as an option for adult patients with SE. Although promising, the results need to be interpreted with caution due to the inherent bias, confounding and small sample size of the included studies. A randomized controlled trial is recommended to establish role of KD in the management of SE in adults.

Seizure-Induced Oxidative Stress in Status Epilepticus: Is Antioxidant Beneficial?

“…KD is a well-known therapeutic option for children with poor control epilepsy [ 105 ]. Mounting evidence also reveals the effectiveness of KD for adults with status epilepticus which denotes the usefulness through dietary adjustment [ 106 , 107 , 108 ]. The diet modification offers another treatment option in patients with refractory epilepsy and warrants to further testify the crucial role of critical condition as in status epilepticus.…”

Ketogenic diets and the nervous system: a scoping review of neurological outcomes from nutritional ketosis in animal studies

“…Chronic pain involves an increase in neuronal excitability (222,223) , with links suggested between these mechanisms and those involved in seizures, and the use of anticonvulsant medications to treat neuropathic pain (18) . A ketogenic diet has been widely used clinically as a treatment for epilepsy with several trials in adults (15) as well as children (224) . A similar interpretive difficulty lies in the animal research for epilepsy where clinical human trials report generally favourable outcomes, but the animal research results can range between anticonvulsant to pro-convulsant outcomes (91,166,175) (Supplementary Table 2).…”

Nutrition in the Neurocritical Care Unit: a New Frontier

“…KDs and their modified forms have been found to reduce seizure frequency by approximately 50% in both pediatric and adult populations regardless of seizure type [43][44][45], efficacy similar to that of medications. A recent systematic review on use of KDs among adult patients with status epilepticus (SE) demonstrated safety and efficacy as adjuvant therapy in SE treatment [46], although should be interpreted with caution due to small sample sizes. Ketogenic diet has been shown to be a feasible and safe therapy for super-refractory status epilepticus (SRSE) [26].…”