General Health, Immunological, Metabolic Syndrome, Neurology

The Impact of a Ketogenic Diet on Autoimmune Encephalitis: A Case Report

Autoimmune encephalitis is a brain inflammation caused by an immune response against neurons, ranking third after viral and postinfectious causes. It often presents with seizures and altered mental status. While standard treatment includes immunotherapy and supportive care, ketogenic diets have shown promise, particularly for drug-resistant seizures. This case report examines the use of a ketogenic diet in a 21-year-old male with autoimmune encephalitis.

The patient presented with high-grade fever, visual hallucinations,  seizures, and fearfulness. His condition deteriorated despite standard care, and further evaluation led to a confirmed diagnosis of autoimmune encephalitis.

Due to persistent seizures and clinical instability, a medically supervised ketogenic diet was initiated, beginning with a 3:1 ratio of fat to carbohydrate-plus-protein and later modified to a 4:1 ratio to enhance therapeutic effects. MCT oil was used to promote ketone production and facilitate seizure control.

Key Findings:

Reduction in Seizure Activity:

• Initial seizure duration decreased upon starting the 3:1 ketogenic diet.
• Transitioning to a 4:1 ketogenic ratio led to a significant reduction in seizure frequency.

Biochemical and Clinical Improvements:

• Markers of inflammation such as liver enzymes (SGOT, SGPT) normalized by the time of discharge.
• Creatine kinase levels, elevated initially, suggested neurological damage but later stabilized.
• Urinary ketones reached 2+, indicating sustained nutritional ketosis.

Cognitive and Functional Recovery:

• The patient progressed to recognizing family members and following commands. He transitioned from tube feeding to oral intake and achieved full recovery.

This case highlights the potential of a ketogenic diet as an adjunctive, nonpharmacological strategy for managing autoimmune encephalitis, particularly when seizures are unresponsive to standard care. The observed improvements in seizure control, biochemical markers, and cognitive function underscore the possible therapeutic role of ketosis in neuroinflammatory conditions. Further research is needed to validate these findings and guide broader clinical application.