Abstracts

The ketogenic diet is effective in reducing seizures in the pediatric population with refractory epilepsy. Limited data are available regarding the efficacy and safety of the diet in adults. It is not clear whether specific epilepsy types may respond more frequently to this diet in this population. This study reviewed the efficacy, tolerability, and nutritional status in a largely adult population treated with the ketogenic diet.
All patients with refractory epilepsy who have been initiated on the ketogenic diet at the Jefferson Comprehensive Epilepsy Center were included. All patients had screening serum studies, including a complete blood count, renal and electrolyte evaluation, liver function tests, fasting lipid panel, vitamin B12, folic acid, serum carnitine, and selenium evaluations. All patients also underwent 12-lead EKGs. No patients had evidence of ischemic heart disease by EKG or history. Patients were initiated on a standard 4:1 (4 gm fat: 1 gm carbohydrate and protein) ratio diet after consultation with a dietician. All diets were initiated in the hospital after an initial period of fasting. Patients received supplemental phosphorus, a multivitamin, calcium supplementation, and a stool softener. Patients enrolled later were also begun on supplemental selenium at the diet onset.
26 patients (15 women, 11 men; mean age 32 years; range 11-51 years) were initiated on the diet. 12 patients had symptomatic generalized epilepsy (SGE); 11 had partial epilepsy; 3 had idiopathic generalized epilepsy (IGE). One patient could not be safely initiated on the diet due to the development of metabolic acidosis in the hospital. Mean diet duration was 7 months (range 0.13 - 25.5 months). 54% of patients had an improvement in seizure frequency (46% had [ge]50% seizure reduction; 5 had [ge] 75% reduction). SGE patients had the greatest response, with 73% of individuals experiencing a [ge]50% seizure reduction. For partial epilepsy, 27% had [ge]50% seizure reduction. 2/3 patients with IGE had [ge] 50% seizure reduction. Cholesterol levels tended to rise (mean pre-diet cholesterol 207.3 (156-304); mean post-diet cholesterol 252.8 (123-395); p = 0.007). Seven patients had reductions in free carnitine level. Selenium was slightly reduced in five patients, but no clinically significant abnormalities occurred. Slight reductions in magnesium, phosphorus, and potassium were seen transiently in one patient each. These abnormalities were reversed with the appropriate supplementation.Weight loss occurred in the majority of patients on the diet (mean [ndash] 6.7 kg; range [ndash]28.6 to +6.8 kg).
The ketogenic diet can be used effectively in adults with refractory epilepsy. These data suggest that response is greatest for patients with SGE in this age group. Routine selenium supplementation should be considered to prevent insufficiencies. Lipids tend to rise but long-term effects are uncertain. Weight loss occurs commonly and adjustment of caloric intake may be necessary.