The ketogenic diet for super-refractory status epilepticus patients in intensive care units

Super-refractory status epilepticus (SRSE) is one of the most challenging issues in intensive care units (ICUs) in that it is associated with high morbidity and mortality. Although the ketogenic diet (KD) has been reported to be effective in treating of SRSE, the use of the diet as therapy can be complicated by concomitant medical problems specific to critically ill patients. In this study, we aimed to describe our experience of the KD for SRSE patients in ICUs. We retrospectively reviewed the medical records of 16 patients (10 males, 6 females) with SRSE who were treated with the KD in the ICUs at Samsung Medical Center from July 2005 to July 2017. The median age of seizure onset was 8 years (interquartile range 5–13.5). Prior to diet initiation, the patients were in convulsive or non-convulsive SRSE for a median of 23 days (range, 3–420). The median time to achieve ketosis was 3 days (range, 2–6). The KD was continued for a median of 2.1 months (range, 0.1–15.8). Of the 16 patients, nine (56.3%) achieved seizure freedom, six (37.5%) reported >50% seizure reduction, and one (6.2%) had