Efficacy and safety of ketogenic diet for treatment of pediatric convulsive refractory status epilepticus
| Autor: | Ann M. Bergin, Tracy A. Glauser, J. Nicholas Brenton, Korwyn Williams, Tobias Loddenkemper, Brian T Burrows, Jessica Harvey, Katrina Peariso, Marina Gaínza-Lein, Yi-Chen Lai, Mohamad A. Mikati, Dmitry Tchapyjnikov, Angus A. Wilfong, Howard P. Goodkin, Ravindra Arya, Iván Sánchez Fernández |
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| Rok vydání: | 2018 |
| Předmět: |
Male
0301 basic medicine Drug Resistant Epilepsy medicine.medical_specialty Adolescent medicine.medical_treatment Status epilepticus Gastroenterology Enteral administration Cohort Studies Young Adult 03 medical and health sciences Epilepsy Status Epilepticus 0302 clinical medicine Refractory Interquartile range Internal medicine Humans Medicine Child Adverse effect business.industry Infant Electroencephalography medicine.disease Treatment Outcome 030104 developmental biology Neurology Child Preschool Female Neurology (clinical) Ketosis medicine.symptom Diet Ketogenic business 030217 neurology & neurosurgery Ketogenic diet |
| Zdroj: | Epilepsy Research. 144:1-6 |
| ISSN: | 0920-1211 |
| Popis: | Purpose To describe the efficacy and safety of ketogenic diet (KD) for convulsive refractory status epilepticus (RSE). Methods RSE patients treated with KD at the 6/11 participating institutions of the pediatric Status Epilepticus Research Group from January-2011 to December-2016 were included. Patients receiving KD prior to the index RSE episode were excluded. RSE was defined as failure of ≥2 anti-seizure medications, including at least one non-benzodiazepine drug. Ketosis was defined as serum beta-hydroxybutyrate levels >20 mg/dl (1.9 mmol/l). Outcomes included proportion of patients with electrographic (EEG) seizure resolution within 7 days of starting KD, defined as absence of seizures and ≥50% suppression below 10 μV on longitudinal bipolar montage (suppression-burst ratio ≥50%); time to start KD after onset of RSE; time to achieve ketosis after starting KD; and the proportion of patients weaned off continuous infusions 2 weeks after KD initiation. Treatment-emergent adverse effects (TEAEs) were also recorded. Results Fourteen patients received KD for treatment of RSE (median age 4.7 years, interquartile range [IQR] 5.6). KD was started via enteral route in 11/14 (78.6%) patients. KD was initiated a median of 13 days (IQR 12.5) after the onset of RSE, at 4:1 ratio in 8/14 (57.1%) patients. Ketosis was achieved within a median of 2 days (IQR 2.0) after starting KD. EEG seizure resolution was achieved within 7 days of starting KD in 10/14 (71.4%) patients. Also, 11/14 (78.6%) patients were weaned off their continuous infusions within 2 weeks of starting KD. TEAEs, potentially attributable to KD, occurred in 3/14 (21.4%) patients, including gastro-intestinal paresis and hypertriglyceridemia. Three month outcomes were available for 12/14 (85.7%) patients, with 4 patients being seizure-free, and 3 others with decreased seizure frequency compared to pre-RSE baseline. Conclusions This series suggests efficacy and safety of KD for treatment of pediatric RSE. |
| Databáze: | OpenAIRE |
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