Neurocritical Care, Hauenstein Neurosciences Mercy Health Saint Mary's, 200 Cherry Street, Grand Rapids, MI, 49503, USA.
Epilepsy Center, Hauenstein Neurosciences Mercy Health Saint Mary's, Grand Rapids, MI, USA.
Neurocrit Care. 2019 Jun;30(3):652-657. doi: 10.1007/s12028-018-0653-2.
Status, refractory status and super refractory status epilepticus are common neurologic emergencies. The objective of this study is to investigate the feasibility, safety and effectiveness of a ketogenic diet (KD) for refractory status epilepticus (RSE) in adults in the intensive care unit (ICU).
We performed a retrospective, single-center study of patients between ages 18 and 80 years with RSE treated with a KD treatment algorithm from November 2016 through April 2018. The primary outcome measure was urine ketone body production as a biomarker of feasibility. Secondary measures included resolution of RSE and KD-related side effects.
There were 11 adults who were diagnosed with RSE that were treated with the KD. The mean age was 48 years, and 45% (n = 5) of the patients were women. The patients were prescribed a median of three anti-seizure medications before initiating the KD. The median duration of RSE before initiation of the KD was 1 day. Treatment delays were the result of Propofol administration. 90.9% (n = 10) of patients achieved ketosis within a median of 1 day. RSE resolved in 72.7% (n = 8) of patients; however, 27.3% (n = 3) developed super-refractory status epilepticus. Side effects included metabolic acidosis, hypoglycemia and hyponatremia. One patient (20%) died.
KD may be feasible, safe and effective for treatment of RSE in the ICU. A randomized controlled trial (RCT) may be indicated to further test the safety and efficacy of KD.
癫痫持续状态、难治性癫痫持续状态和超难治性癫痫持续状态是常见的神经急症。本研究的目的是调查在重症监护病房（ICU）中使用生酮饮食（KD）治疗成人难治性癫痫持续状态（RSE）的可行性、安全性和有效性。
我们进行了一项回顾性、单中心研究，纳入了 2016 年 11 月至 2018 年 4 月期间使用 KD 治疗方案治疗的年龄在 18 至 80 岁之间的 RSE 患者。主要结局指标是尿酮体产生作为可行性的生物标志物。次要测量指标包括 RSE 缓解和 KD 相关副作用。
共有 11 名成年人被诊断为 RSE，并接受 KD 治疗。患者的平均年龄为 48 岁，45%（n=5）为女性。在开始 KD 治疗之前，患者平均服用了三种抗癫痫药物。开始 KD 治疗前，RSE 的中位持续时间为 1 天。治疗延迟是由于丙泊酚的使用所致。90.9%（n=10）的患者在中位数为 1 天内达到酮症。72.7%（n=8）的患者 RSE 得到缓解；然而，27.3%（n=3）的患者发展为超难治性癫痫持续状态。副作用包括代谢性酸中毒、低血糖和低钠血症。1 名患者（20%）死亡。
KD 可能对 ICU 中 RSE 的治疗具有可行性、安全性和有效性。可能需要进行随机对照试验（RCT）进一步测试 KD 的安全性和疗效。
