Key Takeaways
This retrospective study found that in patients with super-refractory status epilepticus (SRSE), parenteral ketosis induction achieved the target ketosis faster than enteral induction.
However, investigators did not observe a difference in the efficacy and duration for SRSE termination between the two routes of ketosis induction.
Both parenteral and enteral ketogenic diet (KD) should be considered for early SRSE treatment.
Super-refractory status epilepticus (SRSE) is characterized by seizure activity lasting at least 24 hours despite treatment with anti-seizure medications. SRSE is challenging to control and is associated with high morbidity and mortality.
Why This Study Matters
The ketogenic diet (KD), a high-fat, low carbohydrate diet, is emerging as a potential treatment option for SRSE. Ketosis can be achieved using enteral or parenteral induction. However, enteral ketosis induction is oftentimes unfeasible and data on parenteral ketosis induction in children is limited. To address this need, this study sought to compare the effectiveness of KD and compare parenteral and enteral induction routes in pediatric SRSE patients.
Study Design
Investigators reviewed the medical records of children < 15 years old diagnosed with SRSE. Participants were treated with KD between 2007 and 2021 at King Chulalongkorn Memorial Hospital in Thailand.
Results and Conclusions
The study consisted of 14 pediatric SRSE patients, ranging from 2 months of age to 13.5 years of age. Ketosis was induced via the enteral route in 8 patients and via the parenteral route for the remaining 6 patients. Patients in the parenteral group achieved significant ketosis faster than those in the enteral group (2 vs 5 days). However, investigators did not report a significant difference in the median time after ketosis induction to SRSE termination. Upon discharge, all survivors (12/14) were seizure-free.
Related Research
Consider these findings from similar research studies:
In a cohort of 8 pediatric SRSE patients treated with KD, 50% responded favorably to the treatment (Source).
KD is a safe and effective treatment for pediatric SRSE patients and should be considered early (Source).
Original Source
Chomtho S, Uaariyapanichkul J, Chomtho K. Outcomes of parenteral vs enteral ketogenic diet in pediatric super-refractory status epilepticus. Seizure. 2022;96:79-85.