Efficacy of the ketogenic diet in children with pharmacoresistant epilepsies

Objectives: The ketogenic diet (KD) is a nutritional therapy based on a high level of fat, controlled protein and reduced carbohydrates, that is applied as treatment for certain metabolic disorders and pharmacoresistant epilepsies. The efficacy of the ketogenic diet was analysed in our own patients that suffered from pharmacoresistant epilepsies.

Material and Methods: 46 patients with therapy refractory epilepsies at the median age of 3.8 years (3m-13.25y) were included, treated with ketogenic diet in the years 1997 till 2004. The frequency of seizures was a median 465/month (1–7500/month), the number of anticonvulsive medications a median 8 (2–16). 3 patients showed side effects (vomiting, apathy) or didn't accept the nutrition and the ketogenic diet was brought to a halt.

Results: Reduction of seizures >50% was noticed in 19/43 patients (44,1%), 9,3% (4/43) became seizure-free, 6,9% (3/43) reached a reduction of >90%, 27,9% (12/43) 50–90%. 55,8% (24/43) were non-responders (seizure reduction <50%). Compared to 2002 we saw a reduced effect of KD. While the first group without seizures remained constant (9,3 versus 10%), there was a drop in the group with reduction of >90% (6,9 versus 24%). At the same time the assignment from epilepsy surgery centres had increased from 27% to 45%.

Conclusions: The efficacy of ketogenic diet in pharmacoresistant epilepsies was confirmed in this study, but there was a reduction compared to 2002. This is probably based on the increased assignment of more severe epilepsies from epilepsy surgery centres. For comparison of the efficacy of therapy concepts a severity score is needed.