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Epilepsy
Pediatrics 1998 Dec;102(6):1358-63
The efficacy of the ketogenic diet-1998: a
prospective evaluation of intervention in 150 children. |
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Freeman
JM, Vining EP, Pillas DJ, Pyzik PL, Casey JC, Kelly LM.
Division of Pediatric Epilepsy, Departments of Neurology and Pediatrics, the
Johns Hopkins Medical Institutions, Baltimore Maryland, USA. |
| OBJECTIVE:
The ketogenic diet is a high-fat, low-protein, low-carbohydrate
diet developed in the 1920s for the treatment of children with
difficult to control seizures. Despite advances in both the pharmacotherapy
and the surgery of epilepsy, many children continue to have difficult-to-control
seizures. This prospective study sought to determine the ketogenic
diet's effectiveness and tolerability in children refractory to
today's medications. METHODS: One hundred fifty consecutive children,
ages 1 to 16 years, virtually all of whom continued to have more
than two seizures per week despite adequate therapy with at least
two anticonvulsant medications, were prospectively enrolled in
this study, treated with the ketogenic diet, and followed for a
minimum of 1 year. Seizure frequency was tabulated from patients'
daily seizure calendars and seizure reduction calculated as percentage
of baseline frequency. Adverse events and reasons for diet discontinuation
were recorded. RESULTS: The children (mean age, 5.3 years), averaged
410 seizures per month before the diet, despite an exposure to
a mean of 6.2 antiepileptic medications. Three months after diet
initiation, 83% of those starting remained on the diet and 34%
had >90% decrease in seizures. At 6 months, 71% still remained
on the diet and 32% had a >90% decrease in seizures. At 1 year,
55% remained on the diet and 27% had a >90% decrease in seizure
frequency. Most of those discontinuing the diet did so because
it was either insufficiently effective or too restrictive. Seven
percent stopped because of intercurrent illness. CONCLUSIONS: The
ketogenic diet should be considered as alternative therapy for
children with difficult-to-control seizures. It is more effective
than many of the new anticonvulsant medications and is well tolerated
by children and families when it is effective. |
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| PMID:
9832569 [PubMed - indexed for MEDLINE] |
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