Abstracts

Almost one-third of the adult patients with epilepsy remain refractory to available medication. In children with incomplete response to the conventional treatment the practice of ketogenic diet (KD) is reported to be highly efficacious. In adults, on the other hand, the experience with KD treatment is limited. The aim of the current study was to assess the efficacy and tolerability of KD in the treatment of adults with refractory epilepsy. Participants consisted of males or females 18-45 years old who suffer from refractory epilepsy with at least 2 disabling partial seizures per month. After 8 weeks of baseline seizure follow-upon a stable anti-epileptic treatment and signing an informed consent, KD treatment was initiated. The treatment period was planned for 3 months with a post-treatment follow-up of 2 months. Fat was the source of at least 90% of the energy consumption with 1gr/kg of protein and a minimal amount of carbohydrate. Dietary consultation was instructed before and during the diet. Daily diaries were used to assess the seizures frequency; daily measurements of the urinary ketones were used to assess compliance with the diet protocols. Lipid levels, liver and kidney functions were assessed at baseline and monthly during the treatment. Out of 49 patients screened only nine initiated the treatment with KD. The main reason for refusal to participate in the study was the concern from the diet protocol. Ketonuria was achieved in all the nine participants within 3 days by combined fasting and gradual KD build-up, without hospitalization. The average KD treatment was 8.8 weeks (range 3-12 weeks). In 4 of the patients the seizure frequency decreased (range 8-69%) but increased in the rest (range 9-72%). Only 3 of the participants were able to complete the 12 weeks treatment. Feeling of hunger and lake of efficacy resulted in withdrawal from the KD in the rest. The levels of ketonuria were unrelated to the efficacy of the KD. Significant increase in the cholesterol levels was noted, related to the length of the KD treatment. KD was partially effective in some of our adult participants with refractory epilepsy. Nevertheless, KD may significantly increase the cholesterol levels and the difficulties to adhere to the KD protocol impose an obstacle upon its usage in independent adults. (Supported by Moshe and Izidora Ishay Institute for Natural Nutrition.)