Considering safety and patient tolerance in the use of ketogenic diet in the management of refractory and super-refractory status epilepticus: a systematic review

ABSTRACT

Introduction

Early use of the ketogenic diet (KD) is described as having a particular interest for super‐refractory status epilepticus and febrile infection-related epilepsy syndrome. The authors conducted a systematic review of the available data on the KD for refractory and super-refractory status epilepticus.

Areas covered

Following a systematic bibliographic search, the authors found 15 published papers: 2 prospective and 13 retrospective studies. Most often, the primary aim of the retrospective studies was the efficacy evaluation of the KD for refractory or super-refractory status epilepticus. Four studies focused on the use of KD for NORSE/FIRES. These initial studies suggested that KD was effective in these conditions, and that it showed mild and manageable side effects.

Expert opinion

The published studies provided enough preliminary data to validate the feasibility and safety of the use of KD for refractory and super-refractory status epilepticus. Further studies demonstrating the efficacy of the KD in these indications are needed. Possible design and endpoints are discussed.

KEYWORDS:

• Ketogenic diet
• refractory status epilepticus
• super-refractory status epilepticus
• NORSE

Article highlights

• Current published studies support the feasibility and safety of the use of KD for refractory status epilepticus and super refractory status epilepticus

• The data on the use of KD for NORSE/FIRES are consistent with the existing literature on status epilepticus.

• Any particular efficacy of the KD in a subgroup of refractory status epilepticus remains to be demonstrated.

Declaration of interest

S Auvin has served as consultant or received honoraria for lectures from Biocodex, Eisai, GW Pharma, Neuraxpharm Nutricia, UCB Pharma, Vitaflo, Xenon, Zogenix. He has been investigator for clinical trials for Eisai, GW Pharma, UCB Pharma, and Zogenix. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.