The efficacy and safety of a ketogenic diet for children with refractory epilepsy in China: a retrospective single-center cohort study

Abstract

Background: The ketogenic diet (KD) has been implemented in many different counties. However, in China, study concerning the efficacy of the KD is still at an early-stage of evaluation. Furthermore, the KD is thought to be incompatible with Chinese children because of its lack of palatability, especially for the Asian population. In addition, its substantial antiepileptic effect remains to be confirmed.Methods: To evaluate the efficacy and safety of the KD treatment of refractory childhood epilepsy in China, we prospectively enrolled 147 children with refractory epilepsy for KD treatment in Guangdong 999 Brain Hospital and followed up the children for 6 months. Outcome was measured by seizure frequencies before and after the KD diet and adverse effects. We also evaluated influences of different variables (starting age, duration of epilepsy, and others) on the outcome. Results:We found after 1 month, 3 months, and 6 months of KD treatment, 28.0%, 55%, and 67.9% of the subjects remained on diet with a >50% seizure reduction and seizure-free rates of 6.5%, 13.2%, and 23.3%, respectively. Gender, starting age, duration, etiology, classification, and seizure type of epilepsy showed no significant influence on efficacy. Anorexia, diarrhea, and gravel were the main side-effects of the KD treatment. Conclusions:In conclusion, the KD is a safe and efficacious method for childhood refractory epilepsy treatment.

Efficacy, Retention Rate, and Influencing Factors of Ketogenic Diet Therapy in Children with Refractory Epilepsy: A Retrospective Study

“…The retention rate in previous study groups ranged from 20 to 80% at 6 months and from 10 to 60% at 12 months and was significantly related to overall clinical teamwork, the educational level of parents, and the efficacy of KD therapy. 8,9,[12][13][14] The data in our report were consistent with the literature, as 69.6 and 41.1% of patients maintained their special diet at 6 and 12 months in our cohort, respectively, and 23.2% still adhered to KD therapy one and a half years later. In our cohort, two common reasons for discontinuing trials were poor curative effects and adverse reactions.…”

VLCKD: a real time safety study in obesity

“…Nausea/vomiting, diarrhea, and constipation are the most common gastrointestinal (GI) side effects of a VLCKD as we also found in our study [constipation (28%), vomiting/nausea (15.1%), diarrhoea (12.3%)] and as already have been reported in studies carried out in normal weight subjects [ 32 – 34 ]. In an RCT, 77 healthy participants were randomized to receive a VLCKD, a low-carbohydrate diet or a low-carbohydrate diet containing 5%, 15% and 25% total energy from carbohydrates, respectively, for 3 weeks [ 32 ].…”

“…Statistically significant increase in diarrhoea and constipation severity was observed in the VLCKD group [ 32 ]. In a prospective study of 147 children with refractory epilepsy conducted to evaluate the efficacy and safety of 6 months KD treatment, the second most common side effect of dietary treatment was diarrhoea [ 34 ]. In another similar study of 12 adults with refractory epilepsy treated with KD for 4 months, mild side effects included nausea/vomiting, constipation, and diarrhoea [ 33 ].…”

Improving the effects of ketogenic diet therapy in children with drug-resistant epilepsy

“…Acidosis and other adverse events were reduced in our cohort, however we note that different studies showed various proportion of adverse events. In our patients the beta-hydroxybutyrate level was physiological or nutritional, only one patient occurred acidosis, which was comparable with Kang HC et al [43] and Li H et al [44]. However, Kim et al [35] found that the incidence of acidosis was 6% at 3 months; Lyczkowski DA et al [45] found that the proportion of metabolic acidosis was 39.4%.…”