Abstracts

The medium chain triglyceride diet (MCT) was introduced by Huttenlocher in the early 1970s for the treatment of refractory epilepsy, after reports showed that MCToil was more ketogenic than other lipids. This in turn allowed less carbohydrate restriction, making the diet easier to be prepared and more palatable than the Classic ketogenic diet. The MCT diet, like the classic ketogenic diet, has been proven more effective in certain types of epileptic seizures and syndromes such as Lennox-Gastaut, and other syndromes were myoclonic-atonic seizures predominate. Few studies have discussed on the efficacy of the MCT oil ketogenic diet for the treatment of lesional epilepsy. The objective of this study is to review the efficacy, in terms of seizure control and tolerance, for patients with partial refractory and lesional epilepsy treated with MCT oil ketogenic diet. Chart review of patients with refractory epilepsy started on MCT oil Ketogenic Diet treatment between 1997-2004 by the current Ketogenic diet staff at the Hospital for Sick Children, Toronto, Canada. In this retrospective analysis, seizure freedom was defined as no seizures reported for 1 year in those patients who had tolerated the diet introduction process, and had remained on the diet for at least 3 months. A total of 39 charts were reviewed. 92.3%of patients (36/39), remained on the diet for 3 months or more. 16.7% (6/36) achieved seizure freedom, 2 of them off medication, for a period of 6 months 23% had [gt]90% seizure reduction, 27% decreased by 50%-90%, and 33% did not significantly improved ([lt]50% seizure frequency reduction ).
The best results were in patients presenting with myoclonic-astatic seizures, but control of multiple seizure types was obtained in some cases. 7/39 (18%), presented with lesional epilepsy. Of these 7 patients, 1 failed diet introduction, 2 had no significant improvement([lt]50% reduction) , but 4 achieved [gt]50%, (2 of them [gt]90%), decrease on seizure frequency.
Cholesterol levels and nutritional status remained within normal limits in all patients on the diet for more than one year. One patient remains active on the diet now for [gt]7 years. One patient died for causes not related to the diet.
Parents reported improvement in behavior, increased alertness, and as a consequence, better school performance in most children who had tolerated the diet and had exhibited a significant decrease in seizure frequency. Interestingly in most of these patients the anticonvulsant medications remained unchanged, and in a few cases the parents decided to maintain the diet not for seizure control, but because the of the behavior improvement only. The MCT ketogenic diet can be effective for treating some patients with refractory lesional epilepsy, and should be consider as a therapeutic option in those patients who are not candidates for surgery or did not achieved the expected seizure control after surgical treatment.