Abstracts

Rationale: There remain a significant number of patients with intractable epilepsy despite trying multiple antiepileptic medications. The ketogenic diet has proven to be an effective tool in some children with intractable epilepsy. The role of the ketogenic diet in adults with intractable epilepsy is not well established. In our rural community-based clinical practice we have found the ketogenic diet to be an effective tool for pediatric patients and since 2004 have expanded our diet-based epilepsy treatment program to include adults with intractable epilepsy.Methods: A retrospective chart review was performed of our electronic medical record system for all adults > 18 years who have utilized the ketogenic diet or modified Atkins diet as a treatment for epilepsy between 2004-2011. Information regarding the patient's seizure frequency before and after initiation of the diet was collected as well as the types of seizures, epilepsy syndrome and other clinical factors. The modified Atkins diet was primarily used in adults rather than the traditional ketogenic diet to help with adherence.Results: 26 adults were started on the diet; 19 on the modified Atkins diet and 7 on the ketogenic diet since October 2004. Seizure types were partial onset, absence, generalized tonic clonic, tonic, and myoclonic. Seizure syndromes included juvenile myoclonic and Lennox Gastaut syndromes. 11 (42%) noted improved seizure control, 6 (23%) reduction in seizure severity, 8 (31%) no change, 1 (3.8%) worsening. 6 (23%) were not on the diet long enough to know effectiveness. None came off all antiepileptic medication. 6 (23%) had reduction in medication. 1 (3.8%) required an increase in medication. 9 (35%) noticed improved alertness. 4 (15%)developed kidney stones. 1 required cholecystectomy for gallstones. 1 (3.8%)developed hyperlipidemia. 14 (54%) came off the diet due to difficulty with adherence, expense, side effects or perceived ineffectiveness. Length of time on the diet ranged from 2 weeks to 54 months. 12 (46%) are still on the diet.Conclusions: Conclusions based on this data are limited by the small number of patients, incomplete data recording, differing time periods on the diet as well as adherence to the diet. Given the intractability of these patients' epilepsy, seeing a reduction in seizure frequency in 42% suggests that the modified Atkins/ketogenic diet is a reasonable option for adults with intractable epilepsy.