Mahmoud Sherif Hanafy, Ho-Huang Ethos, Buhler Jessica
Faculty of Pharmacy and Pharmaceutical Sciences University of Alberta Edmonton AB Canada.
Epilepsia Open. 2019 Nov 24;5(1):10-21. doi: 10.1002/epi4.12370. eCollection 2020 Mar.
Status epilepticus (SE) is a medical emergency that is associated with a significant morbidity and mortality. Recently, there has been significant interest in the use of ketogenic diets (KD) in the management of SE. KD is a high-fat, low-carbohydrate, and adequate protein diet that has been shown to be a safe and effective adjuvant to present SE management in patients with refractory epilepsy. Many case reports and case series have demonstrated the potential safety and effectiveness of KD for the acute treatment of SE; however, quality studies remain scarce on this topic. The purpose of this systematic review is to summarize the available evidence for the safety and effectiveness of KD in adults with SE. A literature search was performed in MEDLINE, EMBASE, Cochrane Library, and CINAHL (September 14, 2018). The search was repeated on March 27, 2019, to include any studies published since the original search. Keywords related to KD and SE were used. Studies were selected based on the reported use of the KD in SE. The search resulted in a total of 954 records. After screening and full-text review, 17 articles were included in this review: four observational studies, 10 case reports, and 3 case series. Based on the observational studies, a total of 38 Patients with SE have been reported. KD was successful in achieving cessation of SE in 31 Patients (82%). The most common adverse effects reported were metabolic acidosis, hyperlipidemia, and hypoglycemia. The current limited evidence suggests that KD might be considered as an option for adult patients with SE. Although promising, the results need to be interpreted with caution due to the inherent bias, confounding and small sample size of the included studies. A randomized controlled trial is recommended to establish role of KD in the management of SE in adults.
癫痫持续状态（SE）是一种医疗急症，与显著的发病率和死亡率相关。最近，生酮饮食（KD）在SE管理中的应用引起了极大关注。KD是一种高脂肪、低碳水化合物且蛋白质充足的饮食，已被证明是难治性癫痫患者当前SE管理的一种安全有效的辅助方法。许多病例报告和病例系列已证明KD对SE急性治疗的潜在安全性和有效性；然而，关于该主题的高质量研究仍然稀缺。本系统评价的目的是总结KD在成人SE患者中安全性和有效性的现有证据。在MEDLINE、EMBASE、Cochrane图书馆和CINAHL（2018年9月14日）中进行了文献检索。2019年3月27日重复检索，以纳入自原始检索以来发表的任何研究。使用了与KD和SE相关的关键词。根据报告的KD在SE中的使用情况选择研究。检索共得到954条记录。经过筛选和全文审查，本评价纳入了17篇文章：4项观察性研究、10例病例报告和3个病例系列。基于观察性研究，共报告了38例SE患者。KD成功使31例患者（82%）的SE停止发作。报告的最常见不良反应是代谢性酸中毒、高脂血症和低血糖。目前有限的证据表明，KD可能被视为成人SE患者的一种选择。尽管前景乐观，但由于纳入研究存在固有偏倚、混杂因素和样本量小的问题，结果需要谨慎解读。建议进行一项随机对照试验，以确定KD在成人SE管理中的作用。
