Favorable response to classic ketogenic diet in a child with anti-GAD 65 antibody mediated super refractory status epilepticus

• Published in: Epilepsy & behavior reports 2022-01, Vol.19, p.100557, Article 100557
• Main Authors: Sivathanu, Deepika, Kewalramani, Deepti, Kumar Manokaran, Ranjith
• Format: Article
• Language: English
• Subjects: Autoimmune encephalitis; Case Report; Classic ketogenic diet; Super refractory status epilepticus
• ISSN: 2589-9864; 2589-9864
• DOI: 10.1016/j.ebr.2022.100557

•Autoimmune encephalitis is a disease condition which presents with refractory seizures in children requiring immunotherapy.•KD is a non-pharmacological treatment modality used worldwide in people with drug-resistant epilepsy. It acts through many anti-inflammatory mechanisms leading to seizure control.•This article highlights the use of adjuvant effect of ketogenic diet in anti GAD-65 antibody positive autoimmune encephalitis.•It is the need of the hour to formulate treatment protocols incorporating newer treatment strategies including KD. Autoimmune encephalitis refers to a spectrum of inflammatory brain diseases which can present as drug-resistant seizures in children. Hereby, we report a case of anti-GAD-65 antibody encephalitis in a 7-year-old child who presented with superrefractory status epilepticus (SRSE). The traditional management with multiple anti-seizure medications at appropriate dosage and immunotherapy was tried despite which the child continued to have seizures. Hence the child was initiated on a classic ketogenic diet. He achieved ketosis within 48 h of diet initiation and there was a drastic reduction in the seizure frequency followed by a completed remission. Hence, this non-pharmacological intervention was an effective adjunct in achieving seizure control in our patient. A ketogenic diet has been sparingly used for the management of post-encephalitic epilepsy and autoimmune epilepsy. However, the data onthe effectiveness of the ketogenic diet in the management of autoimmune encephalitis is scarce. Starting KD early in the disease course helped not only in seizure control but also preserved the cognitive and neurological well-being of the child.