Ketogenic diet in children with pharmacoresistant epilepsy

Aims: Some epilepsy syndromes in childhood (e.g., idiopathic Lennox-Gastaut syndrome) show a distinct pharmacoresistance. Possibly in these cases, the ketogenic diet (KD) is a therapeutic option. Furthermore, KD is first line therapy in children with specific metabolic diseases (e.g., Glut-1 deficiency). We present our results of a retrospective study of patients with KD regarding efficacy, safety, and adverse events.

Methods: Retrospective analysis of 16 patients aged 1 to 19 years (7 female and 9 male) with pharmacoresistant epilepsy (n = 13) or metabolic disease (n = 3) and initiation of KD between the years 2000 and 2011.

Results: In all patients, KD was induced after unsuccessful therapy with at least three antiepileptic drugs. Of the 16 patients, 9 received eight or more antiepileptic drugs before KD was started. After introduction a ketogenic metabolism was achieved in mean after 3 days. Generally, KD was well tolerated, typical adverse events (hypoglycemia, gastrointestinal problems, reduced appetite) occurred only in 4 of the 16 patients and no life-threatening metabolic conditions appeared. During KD, 11 of the 16 patients showed positive effects regarding mental development and seizure frequency; in one patient, a stable disease course was observed. In EEG, one patient showed seizure-free period under KD; however, 4 of the 16 patients had no changes in EEG. After initial improvement of seizure frequency, an increase of seizures occurred during follow-up. In our study population, this problem was the most frequent cause for completing the KD (8/16).

Conclusion: Based on results of our retrospective study, the KD is a safe therapy option for patients with pharmacoresistant epilepsy in childhood. Further studies are needed to estimate the efficacy of KD toward new antiepileptic drugs.