Abstracts

RATIONALE: To examine the potential for cognitive and electrophysiological benefits from the ketogenic diet in children with cognitive epilepsies. The efficacy of the ketogenic diet in decreasing overt seizure frequency in epileptic children who have failed anticonvulsant medications has been reported. Improved EEGs and decreased seizures have lead to cognitive gains and decreased symptoms of hyperactivity and impulsivity. We hypothesized that children with cognitive epilepsies, epileptic disorders that are not manifested by overt clinical seizures but do exhibit abnormal EEG activity particularly in sleep, would show similar improvements from the ketogenic diet. METHODS: Seven children (7 M; avg age 8.51 yrs., range 3.54-13.75 yrs.), who had an abnormal sleep-activated overnight EEG with epileptic activity consistent with subclinical seizures, began the ketogenic diet. Diagnoses included pervasive developmental disorder and continuous spike-wave in sleep syndrome. Progress was assessed by changes in epileptiform activity on 24-hour EEG and neuropsychological assessment (PPVT and WISC-R). RESULTS: EEG improvement was reported in five subjects, normalizing in two, while EEG patterns were unchanged in two subjects. Changes in IQ and PPVT performance did not attain statistical significance (p>.05) and, in fact, demonstrated a decrease in mean scores from baseline to follow-up. Anecdotal reports noted a range of improvement, including eye contact, attention, receptive and expressive language, and behavior; however, some subjects were reportedly worse in domains such as behavior and developmental features. CONCLUSIONS: No significant gains in cognitive functioning were observed in children with cognitive epilepsy placed on the ketogenic diet despite improvements in EEG. It is possible that assessment tools were insensitive to change or that concurrent medications may have hindered data interpretation. Future studies should address these concerns. In summary, despite efficacy in patients with overt epileptic disorders, the ketogenic diet is not a viable treatment option for patients with cognitive epilepsies.