Long-term use of the ketogenic diet in the treatment of epilepsy

Abstract

Long-term outcomes of the ketogenic diet in the treatment of epilepsy have not previously been reported. A retrospective chart review of children treated with the ketogenic diet for more than 6 years at the Johns Hopkins Hospital was performed. The response was documented at clinic visits and by telephone contacts; laboratory studies were obtained approximately every 6 to 12 months. Satisfaction and tolerability were assessed by means of a brief parental telephone questionnaire. In all, 28 patients (15 males, 13 females), currently aged 7 to 23 years, were identified. The median baseline seizure frequency per week at diet onset was 630 (range 1-1400). Diet duration ranged from 6 to 12 years; 19 remain on the diet currently. After 6 years or more, 24 children experienced a more than 90% decrease in seizures, and 22 parents reported satisfaction with the diet's efficacy. Ten children were at less than the 10th centile for height at diet initiation; this number increased to 23 at the most recent follow-up (p=0.001). Kidney stones occurred in seven children and skeletal fractures in six. After 6 years or more the mean cholesterol level was 201mg/dl, high-density lipoprotein was 54mg/dl, low-density lipoprotein was 129mg/dl, and triglycerides were 97mg/dl. Efficacy and overall tolerability for children are maintained after prolonged use of the ketogenic diet. However, side effects, such as slowed growth, kidney stones, and fractures, should be monitored closely.

State of the ketogenic diet(s) in epilepsy

“…Whether these changes lead to chronic atherosclerosis is unknown, but it appears doubtful given that most children discontinue the KD within 2 years. Long-term studies of children on the KD more than 6 years indicate lipid profiles may return to baseline, a trend noticed at 2 years in the previous study [53].…”

“…Height was initially maintained, but the longer patients stayed on the diet and the younger they were, the more at risk they were for not growing along their height percentiles [56]. This appears to persist in children on the diet for over 6 years, with nearly all children less than 10th percentile for height and weight [53]. Somewhat reassuring, however, is the indication that after the KD is stopped, there appears to be catch-up growth to baseline [58].…”

Glucose Uptake and Runx2 Synergize to Orchestrate Osteoblast Differentiation and Bone Formation

“…If this was the case this would further support the notion that skeletal dysplasia may have a nutritional basis (Elefteriou et al, 2006). Moreover, the predilection of osteoblasts for glucose demonstrated here provides a plausible explanation for why children fed chronically a ketogenic diet experience poor longitudinal growth (Groesbeck et al, 2006). …”

Non-Toxic Metabolic Management of Metastatic Cancer in VM Mice: Novel Combination of Ketogenic Diet, Ketone Supplementation, and Hyperbaric Oxygen Therapy

“…We hypothesized that combining these therapeutic regimens could provide an even more significant response in this model. The KD has been used clinically to treat pediatric refractory epilepsy for nearly a century, and is known to be a safe and feasible option for patients [60, 61]. HBOT is an approved therapy for several disease states, including decompression sickness, carbon monoxide poisoning, and radionecrosis [62].…”