Intractable seizure disorders: efficacy of the classic ketogenic diet

ABSTRACT

The ketogenic diet is a high-fat, low carbohydrate, adequate protein diet, developed in the 1920s for the management of intractable seizure disorders in children. To evaluate efficacy and tolerability of the classic ketogenic diet, we analyzed records of the children started on the diet from 1999 to 2006 at the Mofid children's hospital. The subjects were 87 children, mean age 55 months. Before initiation of the diet, 55% of the patients had seizures, at least 1-4 times per day, 36%-5 or more per day and 9%-2 to 4 times per week. Mean number of Anti Epileptic Drugs [AEDs] tried for them was 8 and 67% were receiving three or more drugs. The ketogenic diet showed drastic improvement, with at least 50% reduction in seizure frequency in 87% of our patients, 39% of whom showed complete seizure control in the third month. After one year, in 80% of the patients who returned, improvement continued, with 26% of them being seizure free; besides, 23% had one AED decreased, 36% had two or three AEDs decreased, and 25% [one child] had all AEDs discontinued. Of the 30 improved cases, 20%, at the end of the first year, had improved behavior as well, and 23% of them had become more alert. The medium diet duration of the improved group was 15 months. The improvement in our patients, low side effects, and the duration of diet by families reveal that the ketognic diet can still be a very useful alternative therapy in certain epileptic children