Efficacy of the ketogenic diet in focal versus generalized seizures

Maydell, Bernhard von; Wyllie, Elaine; Akhtar, Nadia; Kotagal, Prakash; Powaski, Kathy; Cook, Kelsey J.; Weinstock, Arie; Rothner, A. David

doi:10.1016/s0887-8994(01)00310-1

Cited by 103 publications

(67 citation statements)

References 18 publications

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“…At the moment, there are no conclusive studies about which type of epileptic seizure responds more favorably to KD, although others reported its effectivity with focal and generalized epilepsy 12 . In our series, the heterogeneity presented by the group did not allow a proper comparison among syndromes.…”

Section: Discussionmentioning

confidence: 99%

Ketogenic diet for the treatment of refractory epilepsy: a 10 year experience in children

Freitas

Paz

Casella

et al. 2007

Arq. Neuro-Psiquiatr.

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Ketogenic diet (KD) is a high fat, low carbohydrate and adequate-protein diet, developed in the 1920's as an attempt to control refractory epilepsy, in an era when available antiepileptic drugs (AED), as well as their efficacy, were limited. There was a renewed interest in the 70s about KD, following a period of disuse during the 40's and 50's 1 . Several hypotheses have tried to explain the mechanism of action of KD. Some of these theories are: metabolic acidosis, extra and intra cellular dehydration, direct action of acetoacetate and b-hydroxybutyrate, and a shift of energy supply sources to the brain 2 . A recent study has shown that, despite advances in neuropharmacology and the development of a new generation of AED, KD remains as an important alternative therapy for epilepsy, especially in children 3 .This study analyzed the long term follow-up of a large series of children with refractory epilepsy who were consecutively enrolled, in the past 10 years, in the KD program of the Children's Institute of the University of São Paulo aiming to evaluate: (i) efficacy KETOGENIC dIET FOR THE TREATMENT OF REFRACTORY EPILEPSYA 10 year experience in children th month, 62.1% had E and 37.9% G. Antiepileptic drugs have been reduced, and generalized epilepsy was the most sensitive. Age-related differences were not observed. Adverse effects were rarely observed. In conclusion, KD proved to be an effective treatment for refractory epilepsy.KEy WoRDS: ketogenic diet, refractory epilepsy, children.Avaliação da dieta cetogênica no tratamento da epilepsia refratária em crianças: 10 anos de experiência RESUMo -A dieta cetogênica (DC) tem alto teor de gordura e baixo de carboidratos e proteínas, sendo usada no tratamento da epilepsia refratária. Analisamos os efeitos da DC em 54 crianças do Instituto da Criança da Universidade de São Paulo. Eficácia, tolerabilidade e efeitos adversos foram estudados. A DC foi considerada eficaz (E) quando houve redução de crises >75% e boa (B) quando a redução foi entre 50-75%. Correlacionamos, quando possível, esses resultados com a síndrome epiléptica e com a idade dos pacientes. observamos resultados (E) em 57,4%, 63,8%, 71,8% e 62,1% dos pacientes no 2º, 6º, 12º e 24º meses, respectivamente e (B) em 31,4%, 25,5%, 25,6% e 37,9%, respectivamente. Houve redução significativa das drogas antiepilépticas. A DC foi mais eficaz nas epilepsias generalizadas e não houve diferenças quanto a idade. Efeitos adversos foram raros. Em conclusão, a DC é um tratamento antiepiléptico eficaz em casos refratários.

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Section: Discussionmentioning

confidence: 99%

Ketogenic diet for the treatment of refractory epilepsy: a 10 year experience in children

Freitas

Paz

Casella

et al. 2007

Arq. Neuro-Psiquiatr.

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“…Moreover, in many children with generalized or genetic refractory epilepsies, epilepsy surgery is not a viable option. However, a ketogenic diet could be tried in the majority of children with refractory epilepsy, at least in theory [3][4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

The efficacy of the ketogenic diet in infants and young children with refractory epilepsies using a formula-based powder

et al. 2016

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To evaluate the efficacy, safety, and tolerability of a classic 4:1 ketogenic diet using a formula-based powder in infants and children with refractory seizures who are reluctant to eat homemade foods. We conducted an open label trial and administered a ketogenic diet using formula-based power (Ketocal). Twenty-seven infants and children aged between 12 months and 5 years were enrolled who had refractory seizures and were reluctant to eat homemade foods. Of 27 children, 5 were lost to follow-up and 22 were remained at the end of the study. After 4 months, the median frequency of seizures per week was reduced >50% in 68.2% of patients, while 9/22 children (40.9%) showed a 50-90% reduction in seizure frequency per week, and 6/22 children (27.3%) showed more than 90% reduction in seizure frequency per week. Over the study course, 6/22 (27%) children who continued to receive the diet developed constipation, one child developed gastroesophageal reflux, and one child developed hypercholesterolemia. None of these children discontinued the diet because of the complications. Thirteen children and their parents (59%) reported that the diet was palatable and tolerable enough. The ketogenic diet using a formula-based powder (Ketocal) is effective, safe, and tolerable in infants and children with refractory seizures who are reluctant to eat homemade foods according to the rules of the ketogenic diet.

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“…Three non-responders were maintained on the diet because of improved quality of life (16,19,22). One seizure-free responder stopped the diet for personal reasons and was lost to follow-up (2).…”

Section: Results (mentioning

confidence: 99%

“…14,15 One study found slightly better results in generalized as opposed to focal epilepsy although this was not significant. 16 Lack of complex focal seizures was reported as a predictive factor for early, complete, and sustained response. 3 However, studies that addressed the effects of the ketogenic diet according to the type of seizures or epilepsy failed to identify any significant difference.…”

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confidence: 99%

The ketogenic diet improves recently worsened focal epilepsy

Villeneuve

Pinton

Bahi‐Buisson

et al. 2009

Develop Med Child Neuro

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Aim We observed a dramatic response to the ketogenic diet in several patients with highly refractory epilepsy whose seizure frequency had recently worsened. This study aimed to identify whether this characteristic was a useful indication for the ketogenic diet. Method From the 70 patients who received the ketogenic diet during a 3‐year period at our institution, we retrospectively selected patients with focal epilepsy. There were 22 children, 13 females and nine males, aged from 5 months to 18 years 6 months (mean 6y 9mo, SD 5y 11mo). Fifteen had symptomatic and seven had cryptogenic focal epilepsy. Seizure frequency 1 week before initiating the ketogenic diet was compared with that at 1 month and at the last visit on the diet. Results Eleven patients were responders (defined as reduction of seizures by more than 50%) at 1 month. Responders were higher (p=0.046) in the group with a recent worsening of seizures than in those with stable seizure frequency. Seven patients were still seizure‐free at 6 months on the diet. Tolerability was excellent in 10 patients. Five patients stopped the diet because of early side effects. Interpretation The ketogenic diet may be a valuable therapeutic option for children with pharmacoresistant focal epilepsy, particularly those with a recent deterioration of seizure control and neurological status. Because of its rapid effect, the ketogenic diet may be a useful support to intravenous emergency drugs in such a situation.

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Efficacy of the ketogenic diet in focal versus generalized seizures

Cited by 103 publications

References 18 publications

Ketogenic diet for the treatment of refractory epilepsy: a 10 year experience in children

Ketogenic diet for the treatment of refractory epilepsy: a 10 year experience in children

The efficacy of the ketogenic diet in infants and young children with refractory epilepsies using a formula-based powder

The ketogenic diet improves recently worsened focal epilepsy

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