Abstracts

RATIONALE:We wanted to see how adults did on the Classic Ketogenic Diet (CKD). METHODS:We have initiated 11 adults onto the CKD since 1996. Of these patients 46% had complex partial seizures, 36% generalized tonic clonic seizures, and 18% mixed seizures. All patients were on the diet a minimum of 1 month. Average diet duration was 12 months. Our protocol was the same as for children with fine tuning of energy substrate moieties by a full time registered dietitian, full time registered nurse, and adult neurologist. Patients were initiated onto the diet the same way as children. Hospital days for the diet decreased from 4 days to 3 days by eliminating concentrated sweets 2 weeks prior to admission and by initiating a low carbohydrate diet for 48 hours before admission. Daily seizure records were kept before and after diet commenced. RESULTS:Based on intention to treat the 11 patients had the following outcomes: none were seizure free, reduction by 9/10 in 3(27%), reduction by 1/2 in 2(18%), no response in 3(27%), non-compliant in 1(10%), and not tolerated in 2(18%). Side effects found with the adults were GI distress, initial weight loss, and constipation. Only one patient had increased cholesterol after being on the diet for a year, and this was corrected by changing the composition of the fat moiety. Of the two patients who did not tolerate the diet, one had reduction by 1/2 for seven months. The diet was efficacious and reduced seizures by at least 1/2 in 54% of the patients, but due to inability to tolerate the diet, only 45% had long-term benefit. CONCLUSIONS:The diet can be useful in highly selected adults. Compliance and tolerance were the primary problems. We are developing ways to improve further compliance and tolerance for this efficacious treatment of intractable seizures. The absence of lipid problems in adults is notable.