Abstracts

The ketogenic diet has been widely used to treat epilepsy since first suggestions that it could mimic the beneficial effect of fasting on seizure control (Wilder, 1921). Although it has been shown to reduce seizure frequency by half in at least 50% of children using it (Lefevre [amp] Aronson, 2000), not all children are able to continue the treatment. The aim of this study was to examine early drop out rate and efficacy of the ketogenic diet in the treatment of children with intractable epilepsy, as part of a randomised controlled trial comparing the Classical and Medium Chain Triglyceride dietary protocols. Interim data is presented on 76 children who were randomised to receive one of two ketogenic diets, either immediately or after a 3 month wait (control group). Reasons for drop out were recorded, and seizure frequency was assessed after 3 months on the diet, compared to that of controls. 18 of the 76 children (24%) discontinued treatment before 3 months: 5 reported gastro-intestinal side effects, 6 had increased seizure frequency, and 7 were unable to cope with the dietary restrictions. A further 11 children (14%) discontinued after the recommended 3 month trial period due to limited efficacy. Seizure results were available for 51 children on the diet and 29 controls. After 3 months, mean percentage of baseline seizures was 70% in the diet group, compared to 146% in controls (P=0.002). 21 of the diet group had greater than 50% seizure reduction, compared to 3 controls (P=0.004). 26 children had a reduction in anti-epileptic medication after 3 months on the diet. Nearly 40% of children started on the ketogenic diet did not continue treatment beyond 3 months. Despite this high drop out rate, many children saw significant benefits, and these interim results from the first randomised controlled trial of the diet support its consideration as a successful treatment for children with drug-resistant epilepsy. (Supported by SHS International.)