The Ketogenic Diet as Broad-Spectrum Treatment for Super-Refractory Pediatric Status Epilepticus: Challenges in Implementation in the Pediatric and Neonatal Intensive Care Units
The Ketogenic Diet as Broad-Spectrum Treatment for Super-Refractory Pediatric Status Epilepticus: Challenges in Implementation in the Pediatric and Neonatal Intensive Care Units
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DOI：
10.1177/0883073813516192
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发表时间：
2015-02-01
影响因子：
1.9
通讯作者：
Matsumoto, Joyce H.
中科院分区：
文献类型：
--
作者：
Cobo, Nicole H.;Sankar, Raman;Matsumoto, Joyce H.
难治性癫痫持续状态具有显著的发病率和死亡率。最近的报道促进了生酮饮食作为难治性癫痫持续状态的有效治疗方法。我们描述了我们最近为4名难治性癫痫持续状态的危重儿童制定生酮饮食的经验，年龄从9周到13.5岁不等，在传统治疗失败后。生酮饮食使这些患者摆脱了持续输注麻醉剂而不会复发癫痫持续状态，尽管延迟酮中毒和持续升高的血糖测量对有效的启动构成了特殊的挑战，没有人经历过完全的癫痫发作停止。与巴比妥酸盐麻醉剂量带来的心肌毒性相比，脂肪酸能量底物更易于维持心肌功能，并有助于生酮饮食的安全性。生酮饮食治疗儿童难治性癫痫持续状态安全有效。
Refractory status epilepticus carries significant morbidity and mortality. Recent reports have promoted the use of the ketogenic diet as an effective treatment for refractory status epilepticus. We describe our recent experience with instituting the ketogenic diet for 4 critically ill children in refractory status epilepticus, ranging in age from 9 weeks to 13.5 years after failure of traditional treatment. The ketogenic diet allowed these patients to be weaned off continuous infusions of anesthetics without recurrence of status epilepticus, though delayed ketosis and persistently elevated glucose measurements posed special challenges to effective initiation, and none experienced complete seizure cessation. The ease of sustaining myocardial function with fatty acid energy substrates compares favorably over the myocardial toxicity posed by anesthetic doses of barbiturates and contributes to the safety profile of the ketogenic diet. The ketogenic diet can be implemented successfully and safely for the treatment of refractory status epilepticus in pediatric patients.