Ketogenic Diet for Refractory Childhood Epilepsy: Beyond Seizures Control, the Experience of a Portuguese Pediatric Centre

Abstract

Introduction: Ketogenic diet is a low carbohydrate diet, which can be used as a treatment for refractory childhood epilepsy. The first aim of this study was to evaluate its efficacy, in patients receiving ketogenic diet for at least three months, on epilepsy control, behaviour and awareness. The secondary aims were to evaluate the variation in the number of antiepileptic drugs, reasons for discontinuing the diet and adverse effects. Material and Methods: Retrospective analysis of clinical records of patients who underwent ketogenic diet for refractory epilepsy, from October 2007 to January 2018, in a tertiary pediatric hospital. Results: In the twenty-nine eligible patients, the mean age of initiation was 7.9 years-old (+/-5.6). Of those, 18 had a ≥ 50% reduction of seizure activity, 19 a marked behaviour improvement and 18 improved awareness. The median number of antiepileptic drugs remained equal for the 15 patients who completed 18 months of treatment (three drugs). The main reason for discontinuing ketogenic diet was a familiar decision. The main adverse effects were hypercholesterolemia (n = 23) and hypertriglyceridemia (n = 21). Discussion: Results were comparable to those of other cohorts, namely age of initiation, proportion of patients completing ketogenic diet, most frequent reasons for stopping and significant improvement of alertness and behavior. Conclusion: Beyond seizure control, patients experienced a marked improvement in behavior and awareness. It is necessary to develop strategies to increase the adherence of families to the diet. RESUMOIntrodução: A dieta cetogénica é uma dieta com baixo teor de hidratos de carbono, que pode ser usada no tratamento da epilepsia infantil refratária. O principal objetivo deste estudo foi avaliar a eficácia nos doentes que completaram pelo menos três meses de dieta, no que respeita ao controlo das crises, comportamento e estado de alerta. Foi também avaliada a variação do número de fármacos antiepiléticos, as razões de descontinuação e os efeitos secundários. Material e Métodos: Análise retrospetiva dos processos clínicos dos doentes com epilepsia refratária sob dieta cetogénica, de outubro de 2007 a janeiro de 2018, num hospital pediátrico de nível 3. Resultados: Nos 29 doentes elegíveis, a média da idade de implementação foi 7,9 anos (+/-5,6). Destes, 18 tiveram uma redução ≥ 50% das crises, 19 tiveram uma melhoria marcada do comportamento e 18 do seu estado de alerta. Dos 15 que completaram 18 meses, a mediana do número de fármacos antiepiléticos permaneceu idêntica à do início (três fármacos). A principal razão de descontinuação foi por decisão familiar. Os principais efeitos secundários foram a hipercolesterolémia (n = 23) e a hipertrigliceridémia (n = 21). Discussão: Os resultados foram semelhantes aos obtidos noutras coortes, nomeadamente no que respeita à idade de início, à percentagem de doentes que completou a dieta, às razões da suspensão e à melhoria do comportamento e estado de alerta. Conclusão: Para além do controlo das crises, os doentes tiveram u...

Effect of a ketogenic diet on decrease of seizures in refractory epilepsy among children (infancy to 14 years old) in Saudi Arabia: a cross-sectional study

“…Wilder first adopted the KD in 1921 and it has been used to treat refractory epilepsy for nearly 100 years ( 3 , 19 ). Its use globally inspired researchers when its beneficial effects were confirmed by several randomized trials ( 20 , 21 ); children on KD were up to three times more likely to be seizure free and up to six times more likely to have ≥50% reduction of seizures compared to children on regular treatment. Seizures in children with refractory epilepsy are uncontrolled with medications and these children have an increased risk of adverse effects, including cognitive impairment and kidney injury ( 22 ).…”

Tolerancia y respuesta a la terapia cetógena en neonatos y lactantes menores de 4 meses. Serie de casos en un centro hospitalario de Medellín, Colombia

“…Ketogenic therapy (KT) has been used for several years as a non-pharmacological therapy for epilepsy, and its effectiveness in the management of refractory epilepsy has been demonstrated in several studies and systematic reviews [ 5 , 6 ]. Those reports focused on children older than 2 years and adults.…”

“…La terapia cetógena (TC) se emplea desde hace varios años como terapia no farmacológica de la epilepsia, y su eficacia en el manejo de la epilepsia refractaria se ha demostrado en estudios y revisiones sistemáticas [ 5 , 6 ]. Durante mucho tiempo, los estudios se enfocaron en niños mayores de 2 años y adultos, pero, en los últimos años, diferentes autores han descrito la seguridad y la eficacia en niños menores de esta edad [ 7 - 10 ]; sin embargo, siguen siendo pocos los estudios realizados en lactantes menores, y especialmente en neonatos.…”

Nanotechnology may provide hope for patients with glucose transporter type 1 deficiency syndrome

“…The ketogenic diet may have adverse effects in many patients. It has been associated with significant long-term adverse effects including osteopenia, hypercholesterolemia, liver steatosis, growth impairment, nephrolithiasis, and cardiovascular risks [1,5]. Furthermore, it can be a very challenging and difficult therapeutic option [5].…”

“…It has been associated with significant long-term adverse effects including osteopenia, hypercholesterolemia, liver steatosis, growth impairment, nephrolithiasis, and cardiovascular risks [1,5]. Furthermore, it can be a very challenging and difficult therapeutic option [5]. As a result, not all patients with Glut1DS are on dietary treatment [4].…”