Abstracts

Rationale: To determine the efficacy of the ketogenic diet in controlling epileptic spasms after failing traditional medication therapy. Epileptic spasms are considered one of the most devastating types of seizures in the pediatric age group. Besides adrenocorticotropic hormone (ACTH) and vigabatrin, there has been limited data on the efficacy of other anti-epileptic medications for its treatment. The ketogenic diet has been shown to be an efficacious non-pharmacological method of treatment for a variety of epileptic syndromes. Methods: We reviewed the charts of 118 pediatric patients on the ketogenic diet in a tertiary epilepsy center. 20 of them have infantile epileptic encephalopathy. All these infants continued to have epileptic spasms with evidence of severe epileptic encephalopathy on electroencephalograms (EEGs) despite treatment with antiepileptic medications. We collected data from the charts of 18 patients in regards to seizure control rates and quality of life improvement at 3, 6 and 12 months visits. Quality of life improvement was charted based on the care giver's perspective. Results: 20 patients were included in the study (16 males, 4 females). Age of spasms onset is 2-9 months (mean 4.5 months). Age of ketogenic diet initiation is 1-34 months (mean 13 months). 15 patients had cryptogenic epileptic spasms; three had perinatal hypoxic ischemic injury, one has lissencephaly and one has STXBP1 mutation. Fifteen patients failed to respond to ACTH and/or vigabatrin before going on the ketogenic diet. The remaining 5 patients tried at least 3 other antiepileptic medications before the diet was started. 67% of the patients had more than 50% seizure reduction (including two patients were seizure free) after starting the diet. This effect was maintained at 3, 6 and 12 months visits. Majority of patients achieved cessation of epileptic spasms within 4-10 weeks (mean 6 weeks) after starting the ketogenic diet. All care givers reported improvement of the quality of life at 3 months visit. This ratio was 80% and 63% at 6 and 12 months visits respectively. Conclusions: The ketogenic diet is a safe and potentially effective method of treatment for patients with epileptic spasms; especially those who did not respond to customary medication therapies.