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

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 K-D early in the disease course helped not only in seizure control but also preserved the cognitive and neurological well-being of the child. (c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

This case report presents a 7-year-old child with anti-GAD-65 antibody encephalitis and superrefractory status epilepticus (SRSE). Despite traditional management with multiple anti-seizure medications and immunotherapy, the child experienced ongoing seizures. However, the initiation of a classic ketogenic diet resulted in ketosis within 48 hours and a significant reduction in seizure frequency, leading to complete remission. This non-pharmacological intervention was found to be an effective adjunct in achieving seizure control and preserving cognitive and neurological well-being in the child.