Introduction:

FIRES is a subcategory of New-Onset Refractory Status Epilepticus that requires a prior febrile infection, with fever starting between 2 weeks and 24 hours prior to onset of refractory Status Epilepticus (SE). Management of these cases presents a huge challenge. We report our experience of using ketogenic diet (KD) as adjuvant therapy in a tertiary care center.

Case Description:

We retrospectively analyzed data of 9 children with FIRES admitted over 9 years who received KD as an adjuvant to anti-epileptics and coma producing therapy. Response was assessed by objective parameters like EEG improvement and duration of coma therapy. The analysis of similar cases who did not receive KD is in process.

Results:

Of the 9 children, 8 were boys and 1 girl. KD was started as adjuvant therapy within 7 days of admission in 5 children and up to 1 month later in the remaining. The mean time of first documentation of EEG improvement after starting the diet was 5.7 days, although there were fluctuations observed. The mean time of starting of tapering coma producing agents was 7.9 days. Complications seen included sepsis (1), metabolic acidosis (4), weight loss (2) and diarrhoea (1).

Conclusion/Discussion:

The response to KD in reducing duration of coma producing therapy and improvement in EEG seems promising. Larger controlled studies are needed to confirm this efficacy and also to study the mechanism of action.