Abstracts

Rationale: Refractory status epilepticus often provides a challenge to the treating physician. The ketogenic diet is a high fat and protein, low carbohydrate diet that is used to treat seizures in the pediatric population. Vagus nerve stimulation is a method of treating seizures whose mechanism of action is not well understood. Neither the ketogenic diet nor vagus nerve stimulation have an indication, nor has either been well-studied, in the setting of refractory status epilepticus in adults. We present the first known report of two adult patients treated with both ketogenic diet and vagus nerve stimulation. Methods: We reviewed our experience of two patients, a 19 year old female with NMDA-receptor antibody encephalitis, and 49 year old male with encephalitis of unknown etiology. Both patients had refractory status epilepticus requiring prolonged (weeks-months) of sedation with propofol, pentobarbital and ketamine, without clinical or electrographic improvement. Eventually the ketogenic diet and vagus nerve stimulation were added to their treatment.Results: The patients experienced improvement of their clinical condition and electroencephalogram within two weeks of implementation of the ketogenic diet and vagus nerve stimulation. The female patient was able to undergo rehabiliton with eventual discharge home. The male patient regained ability to speak and follow commands.Conclusions: The role of the ketogenic diet in the treatment of refractory status epilepticus in adults is not well established, but multiple reports suggest that it is certain instances it is both well tolerated and efficacious. Likewise, though there is no indication for VNS in the treatment of refractory status epilepticus, there are case reports that demonstrate that its efficacy in the setting of refractory status epilepticus. In our literature search, there are have been no other reports showing the use of the ketogenic diet and placement of a vagus nerve stimulator in the setting of refractory status epilepticus. In both cases, the patient was able to make a functional recovery. Further study of the ketogenic diet and vagus nerve stimulation in the setting of refractory status epilepticus are needed.