Efficacy and safety of ketogenic diet，anakinra，and tocilizumab in treatment of febrile infection-related epilepsy syndrome in the acute stage

Liu Wei, Deng Jiong, Sang Tian, Zhang Jie

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Journal of Chongqing Medical University ›› 2025, Vol. 50 ›› Issue (03) : 293-302. DOI: 10.13406/j.cnki.cyxb.003754
Febrile Infection-Related Epilepsy Syndrome Column

Efficacy and safety of ketogenic diet，anakinra，and tocilizumab in treatment of febrile infection-related epilepsy syndrome in the acute stage

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Abstract

Objective To investigate the efficacy and safety of ketogenic diet，anakinra，and tocilizumab in the treatment of febrile infection-related epilepsy syndrome（FIRES） through a meta-analysis. Methods With FIRES，ketogenic diet，anakinra，and tocilizumab as search terms，the databases of PubMed，Embase，Web of Science，the Cochrane Library，Clinicalttrials.gov，CNKI，Wanfang Data，and VIP were searched for related articles published up to December 13，2024. Two reviewers independently screened the articles according to the inclusion and exclusion criteria and assessed the risk of bias of the studies included. Review Manager was used to perform the meta-analysis. Results Among the 549 studies，45 case reports and case series met the inclusion criteria，and there were 45 retrospective studies in total，among which 25，8，and 17 were included in the ketogenic diet group，the tocilizumab group，and the anakinra group，respectively，with 66 patients in the ketogenic diet group，8 in the the tocilizumab group，and 54 in the anakinra group. There were 3 case reports，in which all 3 patients were treated with tocilizumab and anakinra. The meta-analysis showed that in the treatment of FIRES in the acute stage，ketogenic diet，anakinra，and tocilizumab showed a response raet of 68%（95%CI=51%-85%，I2=71%，P<0.01），57%（95%CI=35%-80%，I2=71%，P<0.01），and 100%（95%CI=79%-100%，I2=0%，P=1.00），respectively，with no statistical differences between studies. The survival rate was 96%（95%CI=89%-100%，I2=0%，P=1.00） in the ketogenic diet group，96%（95%CI=89%-100%，I2=0%，P=1.00） in the anakinra group，and 100%（95%CI=80%-100%，I2=0%，P=1.00） in the tocilizumab group. The incidence rate of adverse reactions was 22%（95%CI=7%-37%，I2=81%，P<0.01） in the ketogenic diet group，19%（95%CI=2%-36%，I2=67%，P<0.01） in the anakinra group，and 0%（95%CI=0%-21%，I2=0%，P=1.00） in the tocilizumab group. Conclusion Ketogenic diet，anakinra，and tocilizumab can reduce the frequency of seizures in acute stage of FIRES，and ketogenic diet and anakinra treatment have a relatively high incidence rate of adverse reactions. Hypoglycemia and infection are adverse reactions commonly observed during treatment.

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ketogenic diet / anakinra / tocilizumab / febrile infection-related epilepsy syndrome

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Liu Wei , Deng Jiong , Sang Tian , et al. Efficacy and safety of ketogenic diet，anakinra，and tocilizumab in treatment of febrile infection-related epilepsy syndrome in the acute stage. Journal of Chongqing Medical University. 2025, 50(03): 293-302 https://doi.org/10.13406/j.cnki.cyxb.003754

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