Abstracts

For approximately 20% of children with epilepsy, current available medication is either ineffective in controlling seizures or has unacceptable side effects. One alternative treatment for refractory epilepsy is the ketogenic diet, which involves a strict regimen of high fat, low carbohydrate and low protein foods. Our study sought to utilize existing observational studies to systematically investigate diet effectiveness among pediatric patients with refractory epilepsy. A meta-analysis was performed to assess the evidence for the efficacy of the ketogenic diet in pediatric populations. A MedLine search, from 1970 to 2003 of English language studies was supplemented by articles from reference lists of all articles retrieved. Articles were included if they provided data for pediatric patients who continued or stopped the ketogenic diet at a measurable follow-up point. Using a random effects model, the authors assessed the influence of diet efficacy by comparing patients who continued treatment to those who stopped treatment. Treatment success was defined as achieving greater than 50% seizure reduction. A pooled odds ratio of treatment success was calculated. Nineteen studies involving 331 abstracts met inclusion criteria. Total sample size was 1084 patients (mean age initiation 5.78 [plusmn] 3.42 yrs (range, 0.2-29 yrs)). The pooled odds ratio of treatment success among patients staying on the diet relative to those ultimately discontinuing the diet was 2.25 (95% CI=1.69,2.98). Among patients followed for 24 months (n=860), 49% continued the diet (83.2% achieving success). Seizure type was statistically significant (p[lt]0.005). The highest response rates occurred with generalized seizures, infantile spasms and multiple seizure types. Reasons for diet discontinuation included: [lt]50% seizure reduction (47.0%), diet restrictiveness (16.4%) and incurrent illness/diet side-effects (13.2%). Results indicate that among patients who can tolerate the diet, the ketogenic diet is an effective therapy. The diet is effective among patients with generalized seizures and patients who responded with greater than 50% seizure reduction quickly to the diet (within three months). Current studies regarding the ketogenic diet are of low quality and focus on short-term results. Future studies should aim for improved quality, specifically randomized controlled trials, and focus on the long-term prospects of the diet. (Supported by a cooperative agreement from the Centers for Disease Control and Prevention through the Association of American Medical Colleges, grant number U36/CCU319276-02-3, AAMC ID number MM-0531-03/03. Publication and report contents are solely the responsibility of the authors and do not necessarily represent the official views of the AAMC or the CDC.)