Abstracts

Rationale: The ketogenic diet (KD) has well-established outcomes in both the short and long-term for those receiving it continuously. However, no information exists about long-term effects years after discontinuation. Methods: Living subjects who had been treated at the Johns Hopkins Hospital with the KD from 11/93-12/08 ≥1 month, and had discontinued it ≥ 6 months ago, were identified. Of 493 patients eligible, 217 were successfully contacted and asked to complete a 2-page questionnaire and laboratory studies. Results: 101 subjects, median current age 13 years (range: 2-16 years), participated. The median time since discontinuing the KD was 6 years (range: 0.8-14 years). The mean age at KD discontinuation was older for those who remembered its use, 9.3 vs. 5.9 years (p<0.001). Only 8% reportedly still preferred high fat foods. In comparison to the 52% responder rate at KD discontinuation, 79% were now reportedly >50% improved (p=0.0001). Most (96%) would recommend the KD to others, yet only 54% would have started it before anticonvulsants. In 26 subjects with follow-up labs, liver and kidney functions were normal. Lipids were also normal (mean total cholesterol 158 mg/dl), despite most being abnormal while on the KD. Current height z scores (mean -1.28, 25th percentile), weight (mean -0.79, 36th percentile), and BMI (21.6) for those over 18 years, were also within the expected normal range. Conclusions: This is the first study to report on the long-term effects of the KD years later. Although nearly all parents would recommend it, only half would do so as first-line therapy. Importantly, the KD appears to have long-lasting beneficial effects on seizure control without later adverse effects on growth, lipids, liver or kidney functions.