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SUMMARYPurpose: To conduct the first randomized trial on classical and medium-chain triglyceride (MCT) versions of the ketogenic diet, examining efficacy and tolerability after 3, 6, and 12 months. Methods: One hundred forty-five children with intractable epilepsy were randomized to receive a classical or an MCT diet. Seizure frequency was assessed after 3, 6, and 12 months. Treatment withdrawals were documented. Tolerability was assessed by questionnaire, and blood ketone levels were measured. Results: Of the 61 children who started a classical diet and the 64 who started an MCT diet, data from 94 were available for analysis: 45 classical and 49 MCT. After 3, 6, and 12 months there were no statistically significant differences in mean percentage of baseline seizures between the two groups (3 months: classical 66.5%, MCT 68.9%; 6 months: classical 48.5%, MCT 67.6%; 12 months: classical 40.8%, MCT 53.2%; all p > 0.05). There were no significant differences between groups in numbers achieving greater than 50% or 90% seizure reduction. Serum acetoacetate and b-hydroxybutyrate levels at 3 and 6 months were significantly higher in children on the classical diet (p < 0.01); this was the case at 12 months for acetoacetate. There were no significant differences in tolerability except increased reports in the classical group of lack of energy after 3 months and vomiting after 12 months. Discussion: This study has shown classical and MCT ketogenic diet protocols to be comparable in efficacy and tolerability; both ways of implementing the diet have their place in the treatment of childhood epilepsy.

SUMMARY The classical 4:1 ketogenic diet, the medium‐chain triglyceride (MCT) diet and a modified MCT diet were used in the treatment of 55 children and four adults with intractable epilepsy. During a three‐month treatment period 51 of 63 studies (81 per cent) showed >50 per cent reduction in seizure frequency. This improvement was independent of diet used and type of seizure experienced by patients. The diets were found to be acceptable and of therapeutic benefit to the children, but treatment of the four adult patients with the MCT diet was unsuccessful. There was no correlation between EEG changes and clinical response. The three ketogenic diets were shown to be effective in the short‐term management of children whose epilepsy is poorly controlled with anticonvulsant drugs. RÉSUMÉ Régimes cétogéniques dans le traitement de I'épilepsie: effets cliniques à court terme Le régime cétogénique 4:1, le régime à triglycérides à chaines moyennes (MCT) et un régime MCT modifié, ont été utilisés dans le traitement de 55 enfants et quatre adultes présentant une épilepsie rebelle. Durant la Période de traitement de trois mois, 51 de 63 (81 pour cent) présentant une réduction, de >50 pour cent de la fréquence des crises. Cette amélioration était indépendante du type de régime et de la nature des crises présentées par les patients. Les régimes furent intéressants et bénéfiques pour les enfants mais le traitement par le régime MCT fut inefficace chez les quatre adultes. II n'y eu pas de correlation entre modifications EEG et réponse clinique. Les trois régimes cétogéniques se sont montrés efficaces dans le traitement d'enfants dont I'épilepsie répondait mal aux médications anticomitiales. ZUSAMMENFASUNG Ketogene Diäten bei der Behandlung der Epilepsie: klinische Kurzzeitbeobachtungen Die 4:1 ketogene Diät, die Diät mit mittelkettigen Triglyceriden (MCT) und die modifizierte MCT Diät wurden bei der Behandlung von 55 Kindern und vier Erwachsenen mit unbeeinflußbarer Epilepsie eingesetzt. Innerhalb einer dreimonatigen Behandlungsperiode zeigten 51 von 63 (81 Prozent) eine um 50 Prozent verminderte Anfallshäufigkeit. Diese Besserung war unabhangig von der Art der Diät und unabhängig von der Art der Anfälle. Die Diäten waren akzeptabel und von therpeutischem Nutzen für die Kinder, die Behandlung der vier Erwachsenen mit der MCT Diät jedoch war nicht erfolgreich. Es fand sich keine {Correlation zwischen den EEG‐Veränderungun und dem klinischen Befund. Die drei ketogenen Diäten waren bei einer Kurzzeitbehandlung von Kindern, bei denen die Epilepsie durch Anitkonvulsiva schlecht einzustellen war, erfolgreich. RESUMEN Dietas cetogénicas en el tratamiento de la epilepsia: effectos clínicos a corto plazo El el tratamiento de 55 niños y cuatro adultos con epilepsia resistente, se uso una dieta 4:1 cetogénica, una dieta con triglicéridos de cadena mediana (TCM) y una delta TCM modificada. Durante un tratamiento de tres meses, 51 de 63 (el 81 por ciento) mostraron una reducción del >50 por ciento en las convulsiones. Se vio que las diet...

Both weight and height z scores decreased during diet treatment. By 12 months, there was no difference in outcome between classical and medium-chain triglyceride protocols despite the increased protein in the latter diet.

Summary