Therapeutic augmentation of ketogenic diet with a sodium-glucose cotransporter 2 inhibitor in a super-refractory status epilepticus patient

Abstract

Background: A ketogenic diet (KD) may have a role in treating patients in super-refractory status epilepticus (SRSE). Sodium-glucose cotransporter 2 (SGLT2) inhibitors have a risk of ketoacidosis that could facilitate induction of KD. Case summary: A 42-year-old with a history of drug resistant epilepsy developed SRSE requiring several pharmacological interventions during her hospital course including the initiation of KD that failed. SGLT2 inhibitor therapy was initiated in a successful attempt to augment ketone production. Conclusion: SGLT2 inhibitors may have a therapeutic value in SRSE patients who cannot achieve ketosis with KD alone. Keywords: Ketogenic diet, Ketosis, Ketoacidosis, Status epilepticus, Refractory status epilepticus, Super-refractory status epilepticus, Sodium-glucose cotransporter 2 inhibitor, Epilepsy, Seizure, Pentobarbital