Abstracts

Rationale: The ketogenic diet (KD) has been used as an effective treatment for intractable epilepsy since 1921. More recently its effectiveness was reported in the successful treatment of infants, demonstrating similar seizure reduction rates historically reported in older cohorts. There have been no reports in literature regarding the continuation of breastfeeding concurrent with the KD treatment. Methods: We conducted a retrospective review of charts of the patients that were initiated on the KD at the Massachusetts General Hospital for Children between 2002 and 2007. Two patients were identified that breastfed during their KD treatment.Results: Two patients continued breastfeeding during ketogenic diet initiation and maintenance. Both achieved >90% seizure reduction within the first month of treatment. Patient one was a ten and a half month old male at age of diet initiation after treatment with ACTH and Vigabatrin for infantile spasms and partial seizures. The etiology of his seizures was cortical dysplasia. He continued to nurse twice a day (q AM & PM) for the first three months for a duration of 5-15 min per breast at each feeding and then once a day for the next nine months for the same duration. Each nursing session was followed by a bottle of ketogenic formula at a 4:1 ratio. His ketogenic meals during the day were started at a 2.5:1 ratio and then increased gradually to 3.25:1 ratio. Patient two was an 8-month-old male with a history of trisomy 21 with infantile spasms that proved intractable to ACTH, Topiramate, and Vigabatrin. His seizures were occurring 30-100 times per day. Prior to diet initiation he was receiving a majority of his nutrition through breast milk, nursing every 2-4 hours for an average duration of 20-30 minutes. Upon diet initiation, the mother expressed breast milk to add to his formula. Approximately 15 ml was added per feeding to provide a 3:1 ratio. The seizure frequency reduced to 3-5 per day. The mother discontinued adding breast milk to his formula after 6-8 weeks increasing the diet ratio to 4.7:1 without further reduction or increase in his seizure frequency. Conclusions: Historically it has been thought that mothers cannot continue breastfeeding during the treatment of the KD. It is our experience that mothers are able to provide the benefits of nursing and breast milk while successfully using the KD for treatment of their children’s seizures.