KETOGENIC DIET CAN REDUCE SEIZURE FREQUENCY IN CHILDREN WITH REFRACTORY EPILEPSY.

Aug 24, 1999 (Reuters Health)

A carefully supervised ketogenic diet can significantly reduce seizure frequency in children whose epilepsy has proven refractory to anticonvulsant therapy, Canadian researchers report, confirming the results of previous studies. Dr. Abeer M. Hassan and colleagues, of Children's Hospital of Eastern Ontario, Ottawa, Ontario, report that in a retrospective chart review of 52 children, they noted a greater than 50% reduction in seizure frequency in 35 of 52 patients (67.3%) treated with a ketogenic diet. Six of the 52 children (11.5%) achieved complete seizure control. Forty-nine of the children were treated with the classic 4:1 ketogenic diet, "...four parts fat and one part protein/carbohydrate," Dr. Hassan's team explains in the August issue of Pediatric Neurology. The other three children received a medium chain triglyceride supplement. Mean patient age upon initiation of the diet was 5.5 years. "Thirty-two patients discontinued the diet 3 months or less after initiation," the authors indicate," most commonly because seizure frequency worsened or remained unchanged, or because seizure frequency increased after an initial period of improvement. Among the children who remained on the diet for more than 3 months, treatment lasted an average of 8 months. The investigators note that anticonvulsant medication was reduced in almost 60% of children who responded to the diet with a greater than 50% reduction in seizure frequency. One child discontinued all anticonvulsant medication. Forty percent of children who responded became more alert, according to parent or caregiver reports, and behavior reportedly improved in close to 30% of responders. None of the parameters studied, which included "...age, duration of seizure, type of seizure, sex, or EEG patterns," predicted response to the diet. Constipation developed in 85% of children on the classic 4:1 ketogenic diet, the research team determined. Other adverse events "were uncommon," but one child developed kidney stones, another developed gallbladder stones with biliary colic, and a third experienced severe hypoproteinemia. "In this series, no clinically significant results were found on routine screening," the team writes. "Patients with abnormal blood results presented with specific symptoms or signs to the treating physician. This observation again highlights the need for careful medical and dietary monitoring for patients on the diet, rather than reliance on routine biochemical screening." The only death occurred in a 19-month-old infant who was placed on the diet by her parents, without medical supervision, after they watched a television show about the ketogenic diet. Dr. Hassan and colleagues "...recommend a trial of the ketogenic diet in any child who suffers from medically refractory epilepsy, provided the patient is monitored on a regular basis by medical and dietary staff who are knowledgeable about the diet and its risks."