Neuropediatrics 2008; 39 - V16
DOI: 10.1055/s-0029-1215729

Long-term use of the ketogenic diet in drug resistant epilepsy syndromes during childhood: Differences between responders and non-responders in seizure types, EEG, and outcome

A Dressler 1, E Reithofer 1, B Stöcklin 2, F Benninger 3, M Freilinger 1, E Hauser 4, G Pahs 1, E Reiter-Fink 1, R Seidl 1, P Trimmel-Schwahofer 1, L Urak 1, P Weber 2, M Feucht 1
  • 1Universitätskinderklinik, Medizinische Universität Wien, Abteilung für Allgemeine Pädiatrie und Neonatologie, Wien, Austria
  • 2Universitätskinderspital, Basel, Neuropädiatrie, Basel, Switzerland
  • 3Universitätsklinik für Psychiatrie des Kindes- und Jugendalters, Wien, Austria
  • 4Thermenklinikum Mödling, Pädiatrie, Mödling, Austria

Introduction: The Ketogenic Diet (KD) is a high fat – low carbohydrate diet used for the treatment of drug resistant epilepsy and as first line therapy in GLUT-1 deficiency and pyruvat-dehydrogenase deficiency. The aim of this study was to assess the efficacy and tolerability of the KD in different seizure types and epileptic syndromes, as well as the effect on seizure frequency, and interictal EEG.

Methods: The study is a retrospective chart review. Included were all children and adolescents with epilepsy who started on the KD at the Department of Paediatrics, Medical University of Vienna between March 1999 and May 2008. Responders were defined as being seizure free or having a seizure reduction of ≤50% after six months on the KD. Data on efficacy and tolerability were analysed after three, six, and twelve months using Student's t-test and chi-square (SPSS 15.0.1 for Windows)

Results: Data were available for 50 individuals with a mean age of 9.5 years, SD±5.19). 42% showed a reduction in seizure frequency of ≤50%, 52.3% became seizure-free. 58% (n=39) were non-responders. In the responder group the mean frequency of background activity accelerated significantly (p=0.00) and less epileptic discharges were present (p=0.016) after 6 months. Different seizure types, epilepsy syndromes, blood ketone levels and concomitant antiepileptic drugs AEDs did not significantly influence the responder rate, but a trend towards GTCS responding better than other seizure types was noticed.

Discussion: We noticed – in a comparably high number of patients with long-term follow-up a higher responder-rate than previously reported, and hypothesize that this may be due to a high presence of patients with infantile spasm. Less side effects with no need to interrupt the KD were also observed and may be due to our close monitoring. Study limitations were the retrospective nature and the inhomogenity of our study sample. Outcome results were based on clinical neurological examinations only with no neuropsychological data available.