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Question 1: Is there a role for the ketogenic diet in refractory status epilepticus?
  1. Petros Fessas,
  2. Amedine Duret
  1. School of Clinical Medicine, University of Cambridge, Cambridge, UK
  1. Correspondence to Petros Fessas, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB20SP, UK; pf316{at}

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An 8-year-old girl presents with generalised tonic–clonic seizures that have been previously well controlled with levetiracetam for 5 months. In hospital, she enters status epilepticus, requiring intubation. Despite extensive investigations, no cause is found.

The seizures are refractory to diazepam, phenytoin, levetiracetam and midazolam. General anaesthesia using thiamylal leads to marked hypotension. Attempts to wean thiamylal are followed by continuous electrographic seizures.

The team in charge begins seeking alternatives for achieving seizure cessation in this setting, for which there is no consensus in the paediatric community. The parents share their fears regarding the use of additional medication and enquire about non-pharmacological alternatives, one of which is the ketogenic diet.

Structured clinical question

Does the ketogenic diet (intervention) lead to seizure reduction (outcome) in paediatric refractory or super-refractory status epilepticus (patient/condition)?

Definitions and abbreviations

Refractory status epilepticus (RSE)=resistant to first-line and second-line antiepileptic drugs.

Super-refractory status epilepticus (SRSE)=persistent after 24 hours of general anaesthesia, or recurrent on weaning of general anaesthesia.


The literature was searched for articles on the use of the ketogenic diet as a therapy in children with RSE or SRSE. We excluded articles not in the form of clinical evidence (eg, preclinical reviews), with adult patients only or where the ketogenic …

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  • Contributors PF conceptualised and designed the study and performed the search and initial screening of the articles. AD and PF appraised the evidence, drafted the manuscript and approved the final version.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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