Abstracts

To determine the significance of 2-deoxy-2-[¹⁸F]fluro-D-glucose(FDG)-PET changes between pre and post-KD in association with efficacy of KD and the mechanism of the ketogenic diet in children with intractable epilepsy. We evaluated the changes of PET findings before and after KD in 13 patients (8 male, 5 female; age range from 1year 10months to 7years 4months) with intractable childhood epilepsy (2 partial seizures, 7 infantile spasms, and 4 Lennox-Gastaut syndromes) in relation to anti-epileptic efficacy of KD. FDG-PET was performed prior to KD and 3 months after KD. The changes of glucose metabolism after KD were assessed in various regions including epileptic and non-epileptic cortex, and deep brain structures. We compared the changes of glucose metabolism in patients with seizure-free outcome with patients not successfully controlled by KD and checked the blood keton level. 1) Seven patients (54%) became seizure free after KD, 4 cases (31%) showed seizure reduction over 50% from baseline, and 2 cases (15%) showed no improvement.
2) Glucose metabolism was significantly decreased in most cases after KD.
3) Blood keton levels were markedly elevated in patients with seizure-free outcome.
4) The degree of decreased glucose metabolism was relatively severe in cortex than subcortical structures, such as basal ganglia, thalamus, cerebellum, and brain stem.
5) The degree of glucose metabolism was significantly decreased in seizure-free patients than patients not successfully controlled. The glucose metabolism was significantly decreased after KD especially in cerebral cortex, and KD was more effective efficacy of control of the seizure in patients with more prominent decreased cerebral glucose metabolism. Thus it may be helpful for predicting the outcome of KD.