Abstracts

Ketogenic diet (KD) is a long-time known treatment, effective for seizure control, and often indicated for patients with refractory epilepsy.We carried out the present study in order to speculate how KD should be introduced, and further evaluate its effect over several electrophysiological parameters as well as its efficacy for seizure control. We evaluated prospectively clinical and neurophysiologic parameters of a group of patients submitted to KD treatment in our hospital. For this purpose, 27 patients with refractory epilepsy were selected and submitted to the classic KD. All patients had detailed previous video-EEG studies and 2 optimized anti-epileptic drugs before the beginning of KD treatment. The patients were randomly assigned to 2 groups and were submitted to two different modalities of KD introduction: First group of patients (n=13) was submitted to KD after 24 hours of fasting. The second one was submitted to KD without fasting (n=14). Both groups were compared by age of beginning of the DC, gender, age of epilepsy onset and introduction of KD, time to reach large urinary ketosis, types of epileptic seizures and syndromes, adverse events, efficacy of the KD for seizures control after 2, 6 and 12 months of treatment. Additionally, complete data of an historical series of 13 patients previously submitted to KD after prolonged fasting (24 to 72 hours) in our center were analyzed and included in this study. There were no differences in age of KD introduction, age, gender, age of epilepsy onset, and epilepsy syndrome (focal or generalized) and time to reach strong ketosis among the three groups of patients. Also, there were no differences for seizure control after 2 or 6 months of follow-up among the three groups analyzed. After 6 months and 12 months, the KD was effective in controlling focal or generalized seizures in 46.9% and 37.5% of patients respectively. Corresponding to 25.0% (6 months) and 21.8% (12 months) of patients seizure free or improvement of seizures more than 90%. During KD period, 19 patients were submitted to video-EEG monitoring and 26.3% of them showed improvement on clinical and electroencephalographic parameters. During the introduction of the diet and along the first following days, no differences in the incidence of adverse effects were observed in regard to previous fasting or not. The introduction of KD without a previous fasting period was equally effective in provoking large urinary ketosis as compared to patients submitted to fasting. The incidence of adverse effects of KD was also not different between those groups. Moreover, a fasting period before KD did not affect long-term seizure control. Taken together, our results support the concept that a fasting period before the introduction of KD is not clinically relevant.