Abstracts

Rationale: Increasing numbers of adolescents and adults are considering dietary therapy for refractory epilepsy. Some patients starting diets have earlier experiences with the ketogenic diet when they were infants or children years prior. The outcomes for patients attempting dietary therapy for a second time remains unclear.Methods: Subjects treated with the KD as children who then began either the KD or modified Atkins Diet (MAD) at least 6 months later were evaluated with a chart review. Information about both diet trials was evaluated in regards to seizure reduction, diet duration, and tolerability.Results: Twenty-six patients were identified; with an age at the first diet trial of 5.6 years and second diet trial of 11.5 years. Five were adults when the second diet was started. Most restarted dietary therapy due to persistent seizures (65%) or recurrence after a period of seizure-freedom (19%). Overall, 77% had a >50% seizure reduction with the first diet, 50% with the second diet, p=0.04. However, individual subject responses between diet attempts were largely similar, with 14 (54%) having identical seizure reduction both times, 9 worse (35%), and 3 (16%) better. Three of the five patients who were seizure-free the first diet trial became seizure-free again; conversely 6 of 7 with <50% seizure reduction had similar poor results again. The second diet trial was more likely to lead to >50% seizure reduction if the first trial was started at a later age (7.4 vs. 3.9 years, p=0.04). Tolerability was similar between the MAD and KD, as well as between diet attempts.Conclusions: Attempting a dietary therapy months to years after a previous attempt was feasible and well-tolerated. Results were largely similar between attempts, both positive and negative. As more adults are starting ketogenic diet therapies, and may have tried these therapies when they were younger, this information has practical clinical value.