Evidence map›Paper›PMID 35285036›Full record

ArticleJPEN. Journal of parenteral and enteral nutrition2022

Modified low ratio ketogenic therapy in the treatment of adults with super-refractory status epilepticus.

Neha Kaul, Judy Nation, Joshua Laing, John-Paul Nicolo, Adam M Deane, Andrew A Udy, Patrick Kwan, Terence J O'Brien

Registry-linked trialOpen access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JPEN. Journal of parenteral and enteral nutrition, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07496749 (Ketogenic Diet Treatment for Super-refractory Status Epilepticus), which is not on this map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.5field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07496749 narecruitingnot on this mapstarted 2025, after this paper: background citation

Ketogenic Diet Treatment for Super-refractory Status Epilepticus: a Multicenter, Prospective, Randomized, Controlled Trial

TypeinterventionalSponsorXuanwu Hospital, BeijingRan2025 to 2027Enrolled84ConditionsSuper-refractory Status EpilepticusArmsthe ketogenic diet, Standard Medical Therapy
3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 13 citations in OpenAlex.

  1. Review
  2. Review
  3. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Neha KaulDepartment of Nutrition and Dietetics, Alfred Hospital, Melbourne, Victoria, Australia.ORCID 0000-0003-0790-5200
Judy NationDepartment of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
Joshua LaingDepartments of Neurosciences and Neurology, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.ORCID 0000-0001-8627-0690
John-Paul NicoloDepartments of Neurosciences and Neurology, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.ORCID 0000-0002-0473-6475
Adam M DeaneDepartment of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.ORCID 0000-0002-7620-5577
Andrew A UdyDepartment of Epidemiology and Preventative Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.ORCID 0000-0002-6284-2022
Patrick KwanDepartments of Neurosciences and Neurology, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.ORCID 0000-0001-7310-276X
Terence J O'BrienDepartments of Neurosciences and Neurology, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.ORCID 0000-0002-7198-8621
The Royal Melbourne Hospital · AUThe Alfred Hospital · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundInduction of ketosis by manipulation of nutrition intake has been proposed as an adjunctive treatment for super-refractory status epilepticus (SRSE). However, the classical 4:1 ketogenic ratio may not meet the nutrition needs, specifically protein for critically ill adults. The aim of this study was to analyze the outcomes of adults with SRSE who received a lower ketogenic ratio of 2:1 grams of fat to non-fat grams, including 20%-30% of energy from medium chain triglycerides.

methodsWe reviewed patients aged ≥18 years with SRSE treated with ketogenic therapy between July 2015 and December 2020 at two quaternary teaching hospitals in Melbourne, Australia. Data collected from medical records included patient demographics, nutrition prescription, clinical outcomes, and ketogenic therapy-related complications. The primary outcome of the study was to assess tolerability of ketogenic therapy.

resultsTwelve patients (female = 7) were treated with ketogenic therapy for SRSE. Patients received between 4 and 8 antiseizure medications and 1-5 anesthetic agents prior to commencement of ketogenic therapy. Blood beta-hydroxybutyrate concentrations were variable (median = 0.5 mmol/L, range: 0.0-6.1 mmol/L). SRSE resolved in 10 cases (83%) after a median of 9 days (range: 2-21 days) following commencement of ketogenic therapy. Ketogenic therapy-associated complications were reported in five patients, leading to cessation in two patients.

conclusionDespite the challenge in maintaining ketosis during critical illness, low ratio 2:1 ketogenic therapy incorporating medium chain triglycerides is tolerable for adults with SRSE. Further studies are required to determine the optimal timing, nutrition prescription and duration of ketogenic therapy for SRSE treatment.

Indexed as

Diet, KetogenicKetosisStatus EpilepticusAdolescentAdultCritical IllnessFemaleHumansKetone BodiesMaleTriglyceridesKetone BodiesTriglyceridesbeta hydroxybutyratecritical careintensive care unitketogenic dietketosisneurocritical carestatus epilepticus

Identifiers

PMID35285036
PMCPMC9790306
OpenAlexW4220677224

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.