Bobbie Henry

Ketogenic diet for adults in super-refractory status epilepticus

Objective: To describe a case series of adult patients in the intensive care unit in super-refractory status epilepticus (SRSE; refractory status lasting 24 hours or more despite appropriate anesthetic treatment) who received treatment with the ketogenic diet (KD). Methods: We performed a retrospective case review at 4 medical centers of adult patients with SRSE treated with the KD. Data collected included demographic features, clinical presentation, diagnosis, EEG data, anticonvulsant treatment, and timing and duration of the KD. Primary outcome measures were resolution of status epilepticus (SE) after initiation of KD and ability to wean from anesthetic agents. Results: Ten adult patients at 4 medical centers were started on the KD for SRSE. The median age was 33 years (interquartile range [IQR] 21), 4 patients (40%) were male, and 7 (70%) had encephalitis. The median duration of SE before initiation of KD was 21.5 days (IQR 28) and the median number of antiepileptic medications used before initiation of KD was 7 (IQR 7). Ninety percent of patients achieved ketosis, and SE ceased in all patients achieving ketosis in a median of 3 days (IQR 8). Three patients had minor complications of the KD including transient acidosis and hypertriglyceridemia and 2 patients ultimately died of causes unrelated to the KD. Conclusion: We describe treatment of critically ill adult patients with SRSE with the KD, with 90% of patients achieving resolution of SE. Prospective trials are warranted to examine the efficacy of the KD in adults with refractory SE. Classification of evidence: This study provides Class IV evidence that for intensive care unit patients with refractory SE, a KD leads to resolution of the SE.

Efficacy of dietary therapy for juvenile myoclonic epilepsy

Juvenile myoclonic epilepsy (JME) is often successfully managed with anticonvulsants; however, some patients may have medically resistant seizures. The modified Atkins diet (MAD) has been reported as effective for idiopathic generalized epilepsy and is increasingly being used in adolescents and adults. Since 2006, 8 adolescents and adults have been started on the MAD for JME at Johns Hopkins Hospital. Of these 8 patients, 6 (75%) were female, with a mean age at seizure onset of 10.5 years (range: 6-13 years) and 24.3 years (range: 15-44 years) at MAD initiation. After 1 month, 6 (75%) patients had >50% seizure reduction, and after 3 months, 5 (63%) patients had >50% improvement. Several patients found the MAD difficult to adhere to, including 3 patients who reported temporarily increased seizures during periods of noncompliance. In this limited experience, the modified Atkins diet was an efficacious adjunctive therapy for young adults with very medically resistant JME.

Transitioning pediatric patients receiving ketogenic diets for epilepsy into adulthood

PURPOSE To examine the process for transitioning adolescents on dietary management for intractable epilepsy to adult neurologic care. METHODS Ten patients, ages 6-16 years when the ketogenic or modified Atkins diet was initiated, were identified; age at transition was 18-43 years. All patients were seen at Johns Hopkins Hospital, Baltimore, Maryland. RESULTS Seven remain on diets (4 Ketogenic, 3 modified Atkins diet) at this time with mean diet duration of 15.5 years (range 4-32 years). Most patients had excellent but not complete seizure control and several had recurrence or worsening of seizures with attempts to wean dietary therapy, hence the need to continue. Three main transition options were utilized: (1) continue being followed in pediatric clinic (n=2), (2) establish care with an adult neurologist (n=2), or 3) receive care from the Adult Epilepsy Diet Center (n=6). Those patients followed in the Adult Epilepsy Diet Center were slightly more likely to remain on dietary therapy following transition (5/6 vs. 1/4, p=0.12). CONCLUSION It is important for adolescents with epilepsy receiving ketogenic diets to have transition plans in place for when they become adults. Adult epilepsy diet centers are the ideal option when possible.

Phosphorus Content of Popular Beverages

Carbonated drinks Coke 37.5 6 0.2 Cherry Coke 33.8 6 0 Dr. Pepper 25.9 6 0.2 Diet Dr. Pepper 27.1 6 0.5 Pepsi 31.2 6 0.7 Diet Pepsi 24.1 6 0.3 AMP Energy 30.9 6 0.8 Fruit-Flavored Drinks Crystal Light, Classic Orange 100.5 6 16.0 Crystal Light, Raspberry Ice 2.4 6 0.1 Crystal Light, Fruit Punch 10.9 6 0.5 Tang, Orange 91.1 6 5.0 Kool-Aid, Tropical Punch 2.7 6 0.3 Kool-Aid, Black Cherry 2.4 6 0.1 Kool-Aid, Grape 4.7 6 0.6 Hawaiian Punch, Fruit Juicy Red 77.4 6 0.3 Sunny-D, Tangy Original 68.8 6 0 Sunny-D, Smooth 69.0 6 0.5 Coffee Drinks Starbucks Doubleshot Energy, Mocha 131.2 6 0.2 Starbucks Doubleshot Energy, Vanilla 130.2 6 1.5 Iced Teas Gold Peak Iced Tea, Sweet Tea 6.7 6 0.2 Gold Peak Iced Tea, Lemon 2.5 6 0.2 Lipton Brisk Iced Tea, Sweet Tea 105.2 6 0.8 Lipton Brisk Iced Tea, Lemon 56.9 6 0.5 Lipton Brisk Iced Tea, Raspberry 83.6 6 3.8 Lemonade Crystal Light, Raspberry Lemonade 8.0 6 0.7 Country Time, Lemonade 15.8 6 0.0 Country Time, Pink Lemonade 14.1 6 0.2 Kool-Aid, Pink Lemonade 7.3 6 0.1 Flavored Waters Vitamin Water, Power C Dragonfruit 1.0 6 0 Vitamin Water, Revive Fruit Punch 261.4 6 1.7 Vitamin Water, Focus Kiwi Strawberry 0.9 6 0 Vitamin Water, Essential Orange-Orange 63.4 6 0.7 Vitamin Water, Defense Raspberry Apple 1.5 6 0.1 Vitamin Water Zero, Squeezed Lemonade 86.2 6 1.2 Vitamin Water Zero, Rise Orange 97.7 6 1.7 Mio Fit, Arctic Grape 12.4 6 2.1 Mio Fit, Berry Blast 14.4 6 1.6 SoBe Lifewater, Blood Orange Mango 43.9 6 0.5 Aquafina Flavor Splash, Mixed Berry 56.3 6 0.7 Propel Zero, Berry 54.9 6 0.3 Sports Drinks Gatorade, Frost Glacier Freeze (powder) 20.9 6 3.2 Gatorade, Orange (powder) 21.0 6 4.4 Powerade Zero, Fruit Punch 18.0 6 0.2 Powerade Zero, Orange 18.6 6 0.1 Powerade, Fruit Punch 18.7 6 0.2 Powerade, Orange 18.9 6 0.1

Diet Redux Outcomes from Reattempting Dietary Therapy for Epilepsy

The outcome for patients attempting dietary therapy for epilepsy a second time is unknown. Twenty-six subjects treated with the ketogenic diet as children who then began either the ketogenic diet or a Modified Atkins Diet (MAD) at least 6 months later were evaluated. The mean age at the first diet trial was 5.6 years and at the second diet trial was 11.5 years. Most restarted dietary therapy because of persistent seizures (65%) or recurrence after seizure freedom (19%). Overall, 77% had a ≥50% seizure reduction with the first diet, and 50% with the second diet, P = .04. Individual subject responses were largely similar, with 14 (54%) having identical seizure reduction both times, 9 worse (35%) with the second attempt, and 3 (16%) improved. The second diet trial was more likely to lead to >50% seizure reduction if the first trial was started at a later age (7.4 vs 3.9 years, P = .04).