The ketogenic diet improves recently worsened focal epilepsy

Abstract

Aim We observed a dramatic response to the ketogenic diet in several patients with highly refractory epilepsy whose seizure frequency had recently worsened. This study aimed to identify whether this characteristic was a useful indication for the ketogenic diet. Method From the 70 patients who received the ketogenic diet during a 3‐year period at our institution, we retrospectively selected patients with focal epilepsy. There were 22 children, 13 females and nine males, aged from 5 months to 18 years 6 months (mean 6y 9mo, SD 5y 11mo). Fifteen had symptomatic and seven had cryptogenic focal epilepsy. Seizure frequency 1 week before initiating the ketogenic diet was compared with that at 1 month and at the last visit on the diet. Results Eleven patients were responders (defined as reduction of seizures by more than 50%) at 1 month. Responders were higher (p=0.046) in the group with a recent worsening of seizures than in those with stable seizure frequency. Seven patients were still seizure‐free at 6 months on the diet. Tolerability was excellent in 10 patients. Five patients stopped the diet because of early side effects. Interpretation The ketogenic diet may be a valuable therapeutic option for children with pharmacoresistant focal epilepsy, particularly those with a recent deterioration of seizure control and neurological status. Because of its rapid effect, the ketogenic diet may be a useful support to intravenous emergency drugs in such a situation.

Cognitive Outcomes in Febrile Infection-Related Epilepsy Syndrome Treated With the Ketogenic Diet

“…9 Commercially available KD formula simplifies its use among critically ill children. 10 Several case series have revealed successful KD use in adults and children with SE due to cryptogenic etiology, 11 viral and inflammatory encephalitis, 12,13 hemimegalencephaly, 14 Rasmussen syndrome, and head trauma. 15 In each case, SE resolved 1 to 10 days after KD initiation, even though other treatments failed to abort the SE.…”

The Ketogenic Diet for Medically and Surgically Refractory Status Epilepticus in the Neurocritical Care Unit

“…Although typically used for patients with chronic yet intractable epilepsy, there has been interest in the past several years in the use of the diet as an emergent, acute therapy [13,[20][21][22]. Unlike some medications and the vagus nerve stimulator, dietary treatment appears to work quite rapidly, with large series reporting seizure reduction within typically 2 weeks [23] and sometimes even during the first few days.…”

Mechanisms of Epileptogenesis in Pediatric Epileptic Syndromes: Rasmussen Encephalitis, Infantile Spasms, and Febrile Infection-related Epilepsy Syndrome (FIRES)

“…In addition, although seizures are controlled with suppression-burst coma approaches, they always reappear when barbiturates are weaned [142,143]. A ketogenic diet appeared to stop status epilepticus in almost half of cases, even when administered late during the acute phase with status epilepticus [141,143,144]. In most refractory cases, death may occur after several weeks or months of ongoing seizures.…”