Efficacy and tolerability of olive oil-based ketogenic diet in children with drug-resistant epilepsy: A single center experience from Turkey

Abstract

Purpose: Ketogenic diet (KD) is an effective non-pharmacological treatment for drugresistant epilepsy. The aim of this study was to investigate the efficacy, tolerability and complications of olive oil-based KD in epileptic children. Method: In this single-center, prospective study, patients were followed up at 1, 3, 6 and 12 months after KD initiation. Initially, blood ketone levels were measured daily, and as needed thereafter to maintain the levels between 4 and 5 mmol/L. Patient demographics, seizure frequency, serum biochemistry, abdominal ultrasonography and adverse effects were recorded. Efficacy of KD was defined as !50% seizure reduction. Results: A total of 389 patients with drug-resistant epilepsy receiving KD from 2012 to 2016 were included. One hundred patients (25.7%) stopped the diet for different reasons in the first year, and 369, 314, 225 and 160 patients have been receiving KD treatment for 1, 3, 6 and 12 months, respectively. At 1, 3, 6 and 12th months, 65.8% (243/369), 74.7% (235/314), 70.6% (159/225) and 83.1% (133/160) of the patients were responders, respectively. None of the children had an increased seizure-frequency. Hyperlipidemia (50.8%), selenium deficiency (26.9%), constipation (26.2%), sleep disturbances (20.0%), nephrolithiasis (3.0%), hyperuricemia (3.0) and hepatic side effects (2.6%) were the most common complications of KD. Previous adrenocorticotropic hormone (ACTH) use due to epileptic encephalopathy and presence of constipation at baseline or during KD treatment were found the predictors of treatment efficacy. Conclusion: KD is an effective and well-tolerated treatment option for patients with drugresistant epilepsy. Previous history of ACTH use and constipation during KD treatment are important factors that affect the efficacy of KD treatment.

Efficacy and safety of a ketogenic diet in children with drug-resistant epilepsy

“…In our study, 83.70% patients followed a 2:1 KD ratio, and 78.26% responded to the KD by the rst month of treatment. Our ndings are consistent with those of some previous studies [10][11][12][13] but different from others [14,15] . Our study included a greater number of children who exhibited improvement and whose seizures were managed while following the 2:1 KD ratio.…”

Efficacy and Safety of a Ketogenic Diet in Children and Adolescents with Refractory Epilepsy—A Review

“…However, incidence of constipation was considerably higher at 3 months (cKD: 45%, MCTKD: 33%), 6 months (cKD: 48%, MCTKD: 41%) and 12 months (cKD: 45%, MCTKD: 39%), for those on the cKD. Constipation may be resolved by providing an enema, prescribing polyethylene glycol or by increasing dietary fibers [ 78 , 79 ]. However, others have found reducing or stopping fiber intake to be more effective in decreasing symptoms of constipation [ 80 ].…”

“…When cardiac function was evaluated using imaging, researchers found no significant differences after 1 year of therapy [ 87 ]. Guzel et al implemented the following interventions for those developing hyperlipidemia on an olive-oil based KD—modifying the KD to reduce dietary fat by 20%–25% without affecting blood ketone levels, eliminating egg yolk and saturated fat sources and providing atorvastatin (10 mg/day, by mouth) to block endogenous cholesterol biosynthesis [ 79 ]. Few data are available regarding long-term effects of the KDT in regards to cholesterol.…”

Astrocytes as Guardians of Neuronal Excitability: Mechanisms Underlying Epileptogenesis

“…In addition to the ketogenic diet, other antiepileptic diets have been proposed such as the modified Atkins diet, the medium-chain triglyceride ketogenic diet, and the low glycaemic index treatment (141,142). Ketogenic diets are quite efficient in the alleviation of seizures in children, but also in adults with refractory epilepsy (138,143,144). However, it is difficult to adhere to the diet since it is not palatable.…”

“…However, it is difficult to adhere to the diet since it is not palatable. Furthermore, weight loss, constipation, high level of low-density lipoprotein, and elevated total cholesterol are most frequently reported as adverse effects (143,145). Therefore, alternative approaches to inhibit glycolysis or interfere with lactate formation are studied.…”