Ketogenic Diet: Which Are the Major Factors Related to Discontinuation: Inefficacy or Intolerability?
Abstract number :
3.154
Submission category :
Year :
2001
Submission ID :
3133
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
A.F. Souza, M.D., Child Neurology, Sao Paulo University, Sao Paulo, Brazil; K.D.R. Valente, M.D., Child Neurology, Sao Paulo University, Sao Paulo, Brazil; J.A. Paz, M.D., Child Neurology, Sao Paulo University, Sao Paulo, Brazil; E.B. Casella, Ph.D., Chil
RATIONALE: This study aims to analyze the ketogenic diet[ssquote]s effectiveness and tolerability in children with refractory epilepsy.
METHODS: Sixty-one consecutive patients with refractory epilepsy, ages 10m to 10y11m, were evaluated and admitted to a ketogenic diet (KD) protocol from 1992 to 2000. The KD protocol used was the classical 4:1 suggested by the Johns Hopkins Pediatric Center. All patients had a minimum one-year follow-up. The results were evaluated at 2, 6, 12 and 24 months. Seizure frequency was measured from the patients daily calendar and reduction was compared to the baseline prior to KD. The KD[scquote]s effectiveness was classified as: GI [ndash] [gt]75% seizure control (SC); GII [ndash] from 50 to 75% of SC and GIII- [lt] 50% of SC, being the latter considered as ineffective. Adverse events and the reasons for diet discontinuation were recorded during the evaluations. KD was kept for at least two months before considered as failure.
RESULTS: Thirty children (48.4%) were controlled with KD and presented good compliance to the treatment. All patients reported improvement of quality of life and cognitive skills.
Thirty-one children (51.6%) discontinued the treatment. The major factors related to KD failure were: poor seizure control ([lt]50%) in 35,4% (11 /31) and familial factors in 32,2% (10 / 31).
KD inefficiency led to KD discontinuity mainly in the first 6 months of treatment [17 patients at 2 months and 7 patients at 6 m].
Familial factors included parent non-compliance (5 families), non-achievement of parent expectation (3 children) and treatment cost (2 children). In all these patients, though well tolerated by the children, KD was discontinued.
Other factors related to discontinuity were diet rejection (intolerance) by the children (22,5%) and occasional infectious diseases (6,4%). From the former group, only one patient presented adverse effects such as nausea and vomiting. From the latter, one patient presented sepsis and another nephritis, not related to the diet.
CONCLUSIONS: Ketogenic diet remains as an effective treatment that should be considered in refractory epilepsy due to its efficacy and tolerance in the pediatric population. We believe that rates of inefficacy may be overestimated due to discontinuity caused by familial factors, including socio-economical issues.Proper family advisement seems to play an important role for the continuity of treatment in these series and must be taken in account.