Ketogenic Diet For Refractory Epilepsy In Children- An Institutional Experience

Abstract

Introduction: Ketogenic diet consists in a adequate protein diet (1 qram/kg), low in carbohydrates and rich in lipids, which induces a prolonged state of ketosis that modifies the cerebral energetic metabolism. This study aims to characterize the children with refractory epilepsy treated with ketogenic diet, enrolled in a Child Development Center in Portugal. It intends to evaluate the efficacy and tolerability of the diet and to identify in which epilepsy syndromes and etiologies the diet is effective. Methods: Retrospective analysis of the cases of refractory epilepsy treated with ketogenic diet. Results: Sixteen children were included, eleven boys. The mean age of seizures onset was 13.9 months (0-72 months) and of ketogenic diet onset was 4.4 years (5 months-16 years). At the end of the first month, 62.5% had a seizure reduction of more than 50%. The efficacy reached 43,8% at the end of third month and 31.3% at the end of the sixth month. In 31.3% there was a reduction of the number of anti-epileptic drugs and 56.3% had an improvement in the behavior/cognition. The diet was more effective in infantile spasms, Lennox-Gastaut and Dravet syndromes and genetic and structural epilepsies, particularly in malformations of the cortical development. The mean time to a clinical response was 1.4 months. The diet had a good tolerability, with side effects only in 31.2%, none with clinical severity. Conclusion: In this study, ketogenic diet has proven to be safe and effective and should be considered in children with severe and refractory epilepsies.

A pragmatic study on efficacy, tolerability and long term acceptance of ketogenic diet therapy in 74 South Indian children with pharmacoresistant epilepsy

“…Seizure reduction was stratified into five levels: complete seizure freedom (level 5), reduction of more than 90% (level 4); reduction of 50 to 90% (level 3); reduction of less than 50% (level 2) and no seizure reduction (level 1) as per already published criterion [8,9]. Diet tolerability was evaluated based on diet duration, reasons for discontinuation and documented adverse events.…”

The use of ketogenic diets in children living with drug‐resistant epilepsy, glucose transporter 1 deficiency syndrome and pyruvate dehydrogenase deficiency: A scoping review

“…The most common research type was retrospective cohort study (39.4%, n = 126), 69–194 followed by prospective cohort study (21.9%, n = 70) 195–264 . The remaining quantitative study designs included case series (10.7%, n = 34),…”