Abstracts

To evaluate efficacy, safety and prognosis of the ketogenic diet (KD) in infants, children and adolescents with refractory epilepsy. We undertook a retrospective analysis of epilepsy patients referred and treated with the KD during 1998-2003 by Korean multi-centers. The efficacy and safety of the classic 4:1 KD (87) or initial non-fasting KD (112) as add-on treatment in refractory partial or generalized epilepsies were evaluated. Ketogenic milk was introduced supplementarily in 55 patients and exclusively in five patients. Outcome measures included seizure frequency, EEG findings such as background and epileptiform discharges, and adverse effects during the KD. We also compared between favorable (a reduction of seizure frequency with over 50% and maintenance of KD for over 12 months) group (77) and unfavorable (with less than 50% and for less than 12 months) group (73) to the KD. Of the 199 patients enrolled in this study, male were 110 and female were 89 patients. The mean ([plusmn] SD) age of the patients at the beginning of the KD were 57.9 ([plusmn] 45.7) months and the mean duration of the KD was 13.5 ([plusmn] 10.8) months. Outcomes for a reduction of seizure frequencies at 3, 6, 9 and 12 months after initiating the diet were as followings; 87.9% (175/199), 67.8% (135/199), 55.3% (110/119) and 45.7% (91/119) patients remained on the diet; 61.8% (123/199), 57.3% (114/199), 47.2% (94/199) and 41.2% (82/199) showed a reduction of seizure frequency with over 50% including 35.2% (70/199), 32.7% (65/199), 28.1% (56/199) and 25.1% (50/199) who showed seizure free state. Supplementarily introduced ketogenic milk was well tolerable to most patients. Of five patient who KD was tried exclusively by ketogenic milk, two patients could complete the KD with seizure free state. During the KD, 26.1% (52/199) patients should discontinue the diet due to various complications in 12.1% (24/199) and/or intolerance in 14.1% (28/199) in spite of effectiveness. Five patients died during the KD. The outcomes of seizure reduction between favorable and unfavorable groups were not statistically related to classifications of focal or generalized seizures (p=0.07), age (p=0.62), underlying etiologies (p=0.72). Of 55 patients of favorable group, 76.4% (42/55) showed improvement of backgrounds as well as 68.8% (53/77) showed improvement of paroxysmal discharges. Forty-two patients who had completed the KD with a favorable seizure outcome were followed for mean 27.7 ([plusmn]SD, 22.5) months after the KD and 35.7% (10/42 ) showed a relapse of seizures. The ketogenic diet is a safe and effective therapies for intactable childhood epilepsies but life-threatening complications should be monitored closely during follow-up.