Abstracts

Acute repetitive seizures are a common presenting symptom of encephalitis in children. Occasionally, the seizures are refractory to commonly used antiepileptic drugs (AED). This report reviews one patient with acute repetitive seizures successfully treated with a ketogenic formula. A six year old male was admitted to the ICU in February 2004 with a diagnosis of encephalitis and acute repetitive seizures refractory to six antiepileptic drugs. His seizures were originating from both temporal lobes, lasting up to three minutes, and occuring every 15-30 minutes. Due to the lack of seizure control, options including barbiturate coma and the ketogenic diet were discussed. It was decided to try the diet and initially all IV fluids were changed to normal saline. Total parenteral nutrition was discontinued and an NJ was placed. The following day, a half -strength 4:1 ketogenic diet formula was initiated, and was advanced to full strength after 24 hours. The patient remained on four AEDs during the initiation of the diet including a Versed drip. The ketogenic formula was well tolerated and once the betahydroxybutyrate (BHB) reached 3.8 mmoles, the patient[apos]s seizures stopped and he was able to be extubated. A breakthrough seizure occurred the next day and the BHB was found to be 1.8 moles, due to dextrose containing fluid given with one of the patient[apos]s seizure medications. After return of BHB to previous high levels, the seizures again resolved. Three of the four AEDs were rapidly tapered. The patient was transitioned to oral feedings of a 4:1 ketogenic diet while in the rehabilitation unit. He was discharged and remained seizure free on one AED and the ketogenic diet. The ketogenic diet started on a patient with acute repetitive seizures which were refractory to six AEDs was effective and well tolerated. Within forty eight hours of initiation of a ketogenic formula, the patient was seizure free. Ketosis was easily obtained with NJ feedings. It is important to assure all intravenous fluids used on the ketogenic diet are dextrose free to maintain this ketosis. The ketogenic diet should be considered as an option in patients with acute repetitive seizures.