2025 Volume 32 Article ID: 32_R5
New-onset refractory status epilepticus (NORSE) is an intractable form of status epilepticus where individuals with no prior history of epilepsy suddenly develop seizures. Consideration of a ketogenic diet (KD) is recommended by the American Epilepsy Society. Here we report a case of NORSE with a positive outcome following the introduction of KD under ventilator management. The case was a 27-year-old man with no significant medical history. The patient developed refractory status epilepticus following a COVID-19 infection and was diagnosed with NORSE. Multidrug anticonvulsants and general anesthesia were introduced; however, his seizure control was poor. Although steroids and intravenous immunoglobulins were administered, his seizure was not well-managed, leading to the introduction of KD. In Japan, there are no commercially available KD preparations for adults suitable for tubal feeding, so custom KD was prepared and administered. Although long-term intensive care was required, the patient's seizures were gradually controlled. While the efficacy of KD for refractory status epilepticus in adults has not been confirmed to the same degree as in children, reports emphasizing its efficacy and safety are increasing. KD may also be considered for adult NORSE cases that are difficult to control.
