Abstracts

Rationale: The ketogenic diet has been a successful and widely established method to treat pharmacologically resistant epilepsy for many decades. This study was designed to test the efficacy of the ketogenic diet in different seizure types, in patients reviewed for up to two years in a large tertiary pediatric referral center. Methods: A retrospective chart review was done on patients with pharmacologically resistant epilepsy who were started on a ketogenic diet at Children’s Mercy Hospital between April 2005, and May 2009. 57 patients were identified, with an age ranging between 4 months, and 16 years old at the time of diet initiation. Ketogenic diet ratio ranged between 2.75:1 to 4:1 fat, protein to carbohydrate ratio, using ketocal formula in 14 patients, RCF formula in 13 patients, and oral ketogenic menu diet in 28 patients. Of these patients, 5 had infantile spasms, 26 had generalized epilepsy, and 30 had focal epilepsy, with several having overlapping seizure types. Seizure control was assessed at 1, 3, 12, and 24 months after starting the diet as reported by families during follow up clinic visits, and phone interviews. Results: Data from 53 patients were available for analysis. 4 patients were excluded due to inadequate documentation in the medical records. At one month follow up, 53 patients were on a ketogenic diet. At 3 months, 39 patients, at 6 months, 28 patients, at 12 months, 24 patients, and at 24 months, 12 patients were still on a ketogenic diet. After one month, 28(52.8%) of patients had greater than 50 percent seizure reduction, 16 (30.1%) had less than 50% seizure reduction, and 9(16.9%) had no seizure improvement. At 3 months,28 (66.7%) had greater than 50% seizure reduction, 6(14.3%) had less than 50% seizure reduction, and 8 (19%) had no seizure improvement. At 6 months, 25 (80.6%) had greater than 50% seizure reduction, 4 (12.9%) had less than 50% seizure reduction, and 2 (6.4%) had no seizure improvement. At 12 months, 22 (78.6%) had greater than 50% seizure reduction, 3 (10.7%) had less than 50% seizure reduction, and 3 (10.7%) had no seizure improvement. At 24 months, 12 (85.7%) had greater than 50% seizure reduction, 2 (14.3%) had less than 50% seizure reduction, and 0 (0%) had no improvement. Side effects developed in 13 patients, it was significant enough to stop the diet in 1 patient only. Side effects ranged from gastrointestinal in 6 patients, renal, in 3 patients, neurological in 8 patients, and metabolic in 5 patients. Conclusions: This study documents the efficacy of the ketogenic diet as reported by the patients’ families. Overall most families felt that there was a significant improvement in the overall seizure quantity, and severity, in all epilepsy types. This is somewhat higher than what has been reported in previous studies. These results might be due to the subjective nature of the family reporting. Nevertheless, the low drop out rate combined with the positive perception the diet made in the life of our patients is an important finding.