To characterize the utilization of ketogenic diet (KD) among healthcare providers caring for adult patients with status epilepticus (SE).

KD is a high fat, low carbohydrate diet that has been shown to effectively treat refractory seizures, both in the outpatient and inpatient settings. The successful implementation of KD involves a multifaceted, interdisciplinary approach with many potential barriers. 

27-question web-based survey (Qualtrics®) targeting healthcare providers who manage adult SE patients in both academic and community-based settings distributed by various neurology and critical care specialties societies.

Of 156 respondents, 80% of physicians and 18% of non-physicians reported using KD for SE. Achieving ketosis (36.3%), lack of expertise (24.2%), and lack of resources (20.9%) were identified as some of the most important barriers limiting the utilization of KD. Absence of nutrition support (37.1%) and of pharmacy support (25.7%) were the most important missing resources. Reasons for stopping KD were identified as ineffectiveness (29.1%), difficulty achieving ketosis (24.6%) and side-effects (17.3%). The discrepancies are evident when comparing providers in the academic versus non-academic settings. The former has significantly more experience with the use of KD and EEG monitoring availability, and fewer barriers to its implementation. The need for more randomized clinical trials supporting efficacy (36.5%) and increased practical guidelines for implementation and maintenance of KD (29.6%) were mostly cited as factors to increase the utilization of KD for SE.

We identified multiple target areas to improve the utilization of KD through future research. These include better interdisciplinary collaboration, studies exploring factors affecting the achievement of ketosis and the management of side effects, and large-scale clinical trials examining the efficacy of this treatment. KD represents an underexplored treatment modality which may prove crucial in improving management of SE.