Antiseizure medication reduction and withdrawal in children with drug‐resistant epilepsy after starting the ketogenic diet

Γώγου, Μαρία; Pujar, Suresh; Nemani, Tarishi; Chiang, Chun-Yi; Simpson, Zoe; Hardy, Isobel; Schoeler, Natasha E.; Cross, J. Helen; Eltze, Christin

doi:10.1111/dmcn.15377

Cited by 7 publications

(8 citation statements)

References 32 publications

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“…The underlying mechanism that explains the broad‐spectrum efficacy of KDT is rather multifaceted. Consistent with a previous study, 16 we also observed seizure worsening when reducing ASMs, but it was usually temporary and rarely led to the consequence of adding back the medications. This suggests that the temporary seizure worsening observed during medication reduction does not impact the long‐term outcome of KDT.…”

Section: Discussionsupporting

confidence: 91%

“…Successful withdrawal or reduction of an ASM was defined as a period exceeding 3 months, during which the medication was permanently discontinued or reduced in dosage without the necessity to restart, increase, or initiate any new ASMs throughout the entire follow‐up period (≥9 months). 16 The treatment outcome of KDT was classified as non‐response when the frequency of seizures decreased by less than 50% compared to baseline and as response if the reduction rate was equal to or greater than 50%. The seizure severity after KDT was evaluated according to the patient's seizure diary and was compared to it before treatment.…”

Section: Methodsmentioning

confidence: 99%

“…A recent United Kingdom‐based study revealed that 63% of children with epilepsy could discontinue at least one ASM while undergoing KDT. 16 While various studies have explored ASM adjustments in children during KDT, limited data exist regarding medication adjustments in adults. Notably, differences in drug metabolism between adults and children, along with the feasibility of quantifying ASM load in adults but not in children, underscore the importance of analyzing the reduction and withdrawal of ASMs in adult patients undergoing KDT.…”

Section: Introductionmentioning

confidence: 99%

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Ketogenic diet therapy leads to antiseizure medication reduction in children and adults with drug‐resistant epilepsy

He,

Ye,

Wang

et al. 2024

CNS Neurosci Ther

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AimsThis study aimed to evaluate the safety of reducing or withdrawing anti‐seizure medications (ASMs) in a cohort comprising both adults and children with drug‐resistant epilepsy (DRE) undergoing ketogenic diet therapy (KDT).MethodsWe conducted a comprehensive analysis of clinical profiles in adults and children with DRE who had adhered to KDT for at least 6 months. Successful withdrawal or reduction of an ASM was defined as discontinuation or dose reduction without subsequent resumption or increase and without initiation of any new ASM throughout the entire follow‐up period. Changes in the ASM load were calculated specifically for adult patients.ResultsThe study enrolled 56 participants (34 children and 22 adults) with DRE, with 64.3% achieving successful withdrawal of at least one ASM. The probability of ASM withdrawal remained consistent for children (64.7%) versus adults (63.6%), as well as for responders (62.5%) versus non‐responders (68.8%), and it was not associated with other clinical factors. Early ASM reduction (including withdrawal) after diet initiation occurred in 15 patients (26.8%), with treatment outcomes comparable to those of the remaining participants. Among the 22 adults, the mean values of ASM load reduced by 24.5%, with a similar magnitude observed for responders (24.2%) versus non‐responders (25.1%). In addition, adults tend to have a slower elevation in serum ketone levels compared to children.ConclusionThis study demonstrates the safe achievability of ASM withdrawal through KDT in most patients with DRE, irrespective of age or seizure frequency reduction.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ketogenic diet therapy leads to antiseizure medication reduction in children and adults with drug‐resistant epilepsy

He,

Ye,

Wang

et al. 2024

CNS Neurosci Ther

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“…Although cognitive improvement may occur in the setting of improved seizure frequency, it is also interesting to note that cognitive improvement has been seen following the use of ketogenic interventions in patients with mild cognitive impairment and Alzheimer's disease [35,37]. A study found that following 3-6 months of the ketogenic diet, 63% of patients tolerated a successful withdrawal of at least one antiseizure medication (ASM) [38,39]. Younger age at initiation of the ketogenic diet was a predictor of successful ASM withdrawal [38].…”

Section: Benefits Beyond Seizure Controlmentioning

confidence: 99%

“…A study found that following 3-6 months of the ketogenic diet, 63% of patients tolerated a successful withdrawal of at least one antiseizure medication (ASM) [38,39]. Younger age at initiation of the ketogenic diet was a predictor of successful ASM withdrawal [38].…”

Section: Benefits Beyond Seizure Controlmentioning

confidence: 99%

Dietary carbohydrates in the management of epilepsy

Haridas

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewThe role of dietary carbohydrates in the management of epilepsy is intrinsically linked to the ketogenic diet. The ketogenic diet has been in use for well over a century now. There have been numerous adaptations to the diet. It is crucial to understand the indications and role of the ketogenic diet in the management of epilepsy.Recent findingsThere have been new studies that have looked at the role of ketogenic ratios in seizure control. In addition, there has been new evidence in the role of using the ketogenic diet therapy instead of antiseizure medications. These data highlight that the ketogenic diet should be tailored for patients and caregivers. When used appropriately, it can result in a significant improvement in seizure control as well as cognitive and developmental gains.SummaryThe ketogenic diet therapy has undergone numerous revisions and reiterations from its initial reported use in patients a century ago. This has enabled us to tailor the diet specific to each patient's underlying diagnosis.

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Research progress on the role of inflammatory mediators in the pathogenesis of epilepsy

Yu,

Sun

2024

Ibrain

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Epilepsy is an abnormal neurologic disorder distinguished by the recurrent manifestation of seizures, and the precise underlying mechanisms for its development and progression remain uncertain. In recent years, the hypothesis that inflammatory mediators and corresponding pathways contribute to seizures has been supported by experimental results. The potential involvement of neuroinflammation in the development of epilepsy has garnered growing interest. This review centers attention on the involvement of inflammatory mediators in the emergence and progression of epilepsy within recent years, focusing on both clinical research and animal models, to enhance comprehension of the intricate interplay between brain inflammation and epileptogenesis.

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Antiseizure medication reduction and withdrawal in children with drug‐resistant epilepsy after starting the ketogenic diet

Abstract: Aim: To investigate the rate of successful withdrawal of antiseizure medication (ASM) after starting the ketogenic diet in children and identify predictive factors.

Cited by 7 publications

References 32 publications

Ketogenic diet therapy leads to antiseizure medication reduction in children and adults with drug‐resistant epilepsy

Ketogenic diet therapy leads to antiseizure medication reduction in children and adults with drug‐resistant epilepsy

Dietary carbohydrates in the management of epilepsy

Research progress on the role of inflammatory mediators in the pathogenesis of epilepsy

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