Ketogenic Diet for Refractory Childhood Epilepsy: Beyond Seizures Control, the Experience of a Portuguese Pediatric Centre.
Study Goal
The researchers aimed to evaluate the efficacy of a ketogenic diet in controlling epilepsy, improving behavior and awareness, and assessing reasons for discontinuation and adverse effects in children with refractory epilepsy.
Results Summary
The study found that 18 out of 29 patients had ≥50% reduction in seizures, 19 showed marked behavior improvement, and 18 improved awareness. Hypercholesterolemia and hypertriglyceridemia were common adverse effects, and the main reason for discontinuation was family decision.
Population
Children with refractory epilepsy (mean age 7.9 years).
Effective Dosage
Not specified
Duration
Minimum 3 months, with some patients continuing up to 18 months.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
ketogenic diet | decrease | seizure activity | patients with refractory childhood epilepsy | ≥ 50% | ≥ 50% reduction | #1 |
ketogenic diet | increase | behaviour | patients with refractory childhood epilepsy | - | marked behaviour improvement | #2 |
ketogenic diet | increase | awareness | patients with refractory childhood epilepsy | - | improved | #3 |
ketogenic diet | no change | number of antiepileptic drugs | patients who completed 18 months of treatment | - | remained equal | #4 |
ketogenic diet | increase | hypercholesterolemia | patients with refractory childhood epilepsy | - | main adverse effects were | #5 |
ketogenic diet | increase | hypertriglyceridemia | patients with refractory childhood epilepsy | - | main adverse effects were | #6 |
INTRODUCTION: Ketogenic diet is a low carbohydrate diet, which can be used as a treatment for refractory childhood epilepsy. The first aim of this study was to evaluate its efficacy, in patients receiving ketogenic diet for at least three months, on epilepsy control, behaviour and awareness. The secondary aims were to evaluate the variation in the number of antiepileptic drugs, reasons for discontinuing the diet and adverse effects. MATERIAL AND METHODS: Retrospective analysis of clinical records of patients who underwent ketogenic diet for refractory epilepsy, from October 2007 to January 2018, in a tertiary pediatric hospital. RESULTS: In the twenty-nine eligible patients, the mean age of initiation was 7.9 years-old (+/- 5.6). Of those, 18 had a ≥ 50% reduction of seizure activity, 19 a marked behaviour improvement and 18 improved awareness. The median number of antiepileptic drugs remained equal for the 15 patients who completed 18 months of treatment (three drugs). The main reason for discontinuing ketogenic diet was a familiar decision. The main adverse effects were hypercholesterolemia (n = 23) and hypertriglyceridemia (n = 21). DISCUSSION: Results were comparable to those of other cohorts, namely age of initiation, proportion of patients completing ketogenic diet, most frequent reasons for stopping and significant improvement of alertness and behavior. CONCLUSION: Beyond seizure control, patients experienced a marked improvement in behavior and awareness. It is necessary to develop strategies to increase the adherence of families to the diet. Introdução: A dieta cetogénica é uma dieta com baixo teor de hidratos de carbono, que pode ser usada no tratamento da epilepsia infantil refratária. O principal objetivo deste estudo foi avaliar a eficácia nos doentes que completaram pelo menos três meses de dieta, no que respeita ao controlo das crises, comportamento e estado de alerta. Foi também avaliada a variação do número de fármacos antiepiléticos, as razões de descontinuação e os efeitos secundários. Material e Métodos: Análise retrospetiva dos processos clínicos dos doentes com epilepsia refratária sob dieta cetogénica, de outubro de 2007 a janeiro de 2018, num hospital pediátrico de nível 3. Resultados: Nos 29 doentes elegíveis, a média da idade de implementação foi 7,9 anos (+/– 5,6). Destes, 18 tiveram uma redução ≥ 50% das crises, 19 tiveram uma melhoria marcada do comportamento e 18 do seu estado de alerta. Dos 15 que completaram 18 meses, a mediana do número de fármacos antiepiléticos permaneceu idêntica à do início (três fármacos). A principal razão de descontinuação foi por decisão familiar. Os principais efeitos secundários foram a hipercolesterolémia (n = 23) e a hipertrigliceridémia (n = 21). Discussão: Os resultados foram semelhantes aos obtidos noutras coortes, nomeadamente no que respeita à idade de início, à percentagem de doentes que completou a dieta, às razões da suspensão e à melhoria do comportamento e estado de alerta. Conclusão: Para além do controlo das crises, os doentes tiveram uma marcada melhoria do seu comportamento e estado de alerta. É necessário desenvolver estratégias para aumentar a adesão das famílias à dieta.