COMPARATIVE STUDY OF EFFICACY OF STANDARD TREATMENT VS STANDARD TREATMENT ALONG WITH KETOGENIC DIET IN PEDIATRIC REFRACTORY STATUS EPILEPTICUS

Abstract

Objective: To compare the efficacy of standard anti-seizure treatment alone versus standard treatment combined with the ketogenic diet in children with RSE.

Study Place: This Quasi-experimental study was conducted at the Department of Pediatric Neurology, The Children's Hospital, UCHS, Lahore from 1st December 2024 to 8th June  2025.

Methodology: 42 children aged 1–18 years with RSE were enrolled. All patients were initially managed with standard anti-seizure therapy. Due to inadequate response, KD was introduced  approximately 7 days after the onset of status epilepticus. Patients were then divided into two groups: 21 received standard therapy alone, and 21 received adjunctive KD.

Results: In the KD group (n = 21), seizure reduction ≥50% was achieved in 16 patients (76.2%), EEG recovery within 7 days in 15 patients (71.4%), and IV  midazolam discontinuation within 2 weeks in 16 patients (76.2%). Ketosis was achieved in 18 patients (85.7%) within approximately 2 days. Adverse effects were reported in 11 patients (52.4%), with only one patient requiring discontinuation of KD.

Conclusion: Ketogenic diet is a safe and effective adjunct to standard therapy in pediatric RSE. Early KD initiation significantly improves seizure control, EEG recovery, and facilitates midazolam infusion withdrawal. These findings support its timely use in refractory cases.