The Fat is in the Fire: Ketogenic Diet for Refractory Status Epilepticus

Status epilepticus has a high degree of long-term functional poor outcomes, with mortality rates as high as 50% (1).Standard anticonvulsant treatments include benzodiazepines, phenytoin, and phenobarbital; newer agents include levetiracetam and valproate (2).Unfortunately, status epilepticus can remain refractory to these interventions, at times requiring anesthetics such as pentobarbital, midazolam, propofol, and ketamine to achieve burst suppression (2).Yet even these treatments can eventually fail, with patients experiencing persistent seizures when they are weaned off general anesthesia.Sadly, few other options are then available.The ketogenic diet is a high-fat, low-carbohydrate nonpharmacologic treatment for epilepsy (3).In continuous use since 1921, over the past two decades, there has been a dramatic resurgence in research and clinical interest in this therapy, typically for children with intractable epilepsy.There is a misperception that the ketogenic diet is universally comprised of bacon, eggs, and heavy whipping cream.The reality is that several all-liquid ketogenic formulas exist and can be provided by a trained dietitian, typically for infants and children with gastrostomy tubes (3).