Sivathanu Deepika, Kewalramani Deepti, Kumar Manokaran Ranjith
Department of Paediatrics, Chettinad Hospital and Research Institute, Kelambakkam, TN 603103, India.
Division of Pediatric Neurology, Department of Neurology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, 600116, India.
Epilepsy Behav Rep. 2022 Jun 7;19:100557. doi: 10.1016/j.ebr.2022.100557. eCollection 2022.
Autoimmune encephalitis refers to a spectrum of inflammatory brain diseases which can present as drug-resistant seizures in children. Hereby, we report a case of anti-GAD-65 antibody encephalitis in a 7-year-old child who presented with superrefractory status epilepticus (SRSE). The traditional management with multiple anti-seizure medications at appropriate dosage and immunotherapy was tried despite which the child continued to have seizures. Hence the child was initiated on a classic ketogenic diet. He achieved ketosis within 48 h of diet initiation and there was a drastic reduction in the seizure frequency followed by a completed remission. Hence, this non-pharmacological intervention was an effective adjunct in achieving seizure control in our patient. A ketogenic diet has been sparingly used for the management of post-encephalitic epilepsy and autoimmune epilepsy. However, the data onthe effectiveness of the ketogenic diet in the management of autoimmune encephalitis is scarce. Starting K early in the disease course helped not only in seizure control but also preserved the cognitive and neurological well-being of the child.
自身免疫性脑炎是指一系列炎症性脑疾病，在儿童中可表现为药物难治性癫痫发作。在此，我们报告一例7岁患有超级难治性癫痫持续状态（SRSE）的抗谷氨酸脱羧酶65（GAD-65）抗体脑炎患儿。尽管尝试了使用多种适当剂量的抗癫痫药物进行传统治疗以及免疫治疗，但该患儿仍持续癫痫发作。因此，该患儿开始采用经典生酮饮食。在饮食开始后的48小时内他实现了酮症，癫痫发作频率大幅降低，随后完全缓解。因此，这种非药物干预是我们患者实现癫痫控制的有效辅助手段。生酮饮食已被少量用于治疗脑炎后癫痫和自身免疫性癫痫。然而，关于生酮饮食在自身免疫性脑炎治疗中有效性的数据很少。在疾病病程早期开始生酮饮食不仅有助于控制癫痫发作，还能保护患儿的认知和神经健康。
