Intravenous ketogenic diet therapy in the acute phase of AERRPS

A ketogenic diet is reportedly effective in controlling intractable seizures in the acute phase of AERRPS. However, if patients with AERRPS experience intestinal failure as an adverse effect of antiepileptic drugs and anesthetics, initiating ketogenic diet therapy may become difficult. A 13-year-old male patient was admitted due to fever, focal to bilateral tonic-clonic seizures and disturbance of consciousness on 6 days of illness. Although multiple antiepileptic drugs and intravenous anesthetics, including high-dose phenobarbital, were administered, the frequency of his seizures increased. Acute encephalitis with repetitive refractory partial seizures (AERRPS) was diagnosed based on his clinical course. To reduce the frequency of the seizures, ketogenic diet therapy was begun on day 14 after onset. Intravenous ketogenic diet therapy was administered concurrently with enteral ketogenic diet therapy. After maintaining these dietary regimens concurrently for six days, the intravenous regimen was discontinued when the ketone bodies in the serum reached a satisfactory concentration and the seizure frequency declined. There was no adverse event requiring intervention. Our experience suggested that short-term intravenous ketogenic diet therapy can be performed safely if the liver and pancreatic enzymes and lipid profile are carefully monitored and may provide a treatment option for patients with intestinal failure in the acute phase of AERRPS.