Abstracts

RATIONALE: To study the efficacy and side effects of KD in a large Canadian cohort. METHODS: Five Centres entered data from all patients started on the diet 1995 - 1998. RESULTS: Of 196 patients 120 completed the diet, 70 remained on the diet, 6 were lost to follow-up: 112 males, 84 females mean age 6.9 years at diet start (6 wks-20 yrs). Mean Age of seizure (Sz) onset 19 months (3 wks-12 yrs). 47 (24%) had a single Sz type, 148 (86%) had 2-6 Sz types, 1 unknown, and all had failed multiple anti-epileptic drugs. Sz status at diet end: Sz free - 26 (13.3%); > 90% decrease in Sz - 51 (26%); > 50% decrease in Sz - 57 (29%), unchanged 55 - (28%), worse - 7 (3.6%). Effect of KD on some Sz types - Lennox Gastaut (LG) (n = 31): Sz free - 3 (9.7%); > 90% decrease - 6 (19.4%); > 50% reduction - 11 (35.5.%); unchanged - 9 (29%); worse - 2 (6.5%). Partial Complex (PC) only (n = 7): Sz free - 1; > 90% decrease - 2; > 50% decrease - 2; unchanged 2. Side effects: At start of diet (n = 196) vomiting 44 (22.2%), hypoglycaemia 26 (13%). During diet, constipation 55 (28%). Cholesterol measured at 6 mo. (n = 55) - 25 (45.5%) had moderate to high serum cholesterol (range 6-10 mmol/L) (N < 4.6 mmol/L) and at 12 mo. 27 (49%) had levels range 6-12 mmol/L. Protein levels had decreased from start of diet in 15 (n = 22) patients, range 45 - 60 g/L (N 60-82 g/L) and in 8 at 12 mo. Albumen decreased to range 22 - 30 g/L (N 33-46 g/L)in the same group. Renal stones (n = 190) 9 (4.5%). CONCLUSIONS: These observations confirm previous reports of efficacy of KD. LG patients warrant further study to determine if earlier use would prevent cognitive deterioration seen in this syndrome. Low numbers of children with PC Sz reflect negative reports of efficacy on partial seizures. A larger prospective study is needed to confirm our results. Vomiting, hypoglycaemia at start, constipation and renal stones during KD are well documented. The incidence of renal stones here is lower than reported. Previously unreported increased lipids and low proteins are concerning. Research is needed with reference to (a) modifying the 1 gm/kg protein used currently in the classic diet and (b) to develop a diet with less saturated fat. A collaborative study is being planned to address these questions systematically.