Efficacy, Retention Rate, and Influencing Factors of Ketogenic Diet Therapy in Children with Refractory Epilepsy: A Retrospective Study

Abstract

Aim This study aimed to evaluate the efficacy and retention rate of a ketogenic diet (KD) and assess factors that influence the efficacy of KD therapy in children with refractory epilepsy (RE). Methods We retrospectively studied the efficacy and retention rate of 56 RE children who accepted KD therapy from January 2013 to December 2019. Patients who had a ≥50% reduction in seizure frequency were defined as responders. The retention rate was calculated as the proportion of children who continued KD/the total number of children who were followed up at the time of enrollment. We also analyzed the effects of different factors (such as gender, KD initial age, KD duration, the type of epilepsy syndrome, and others) on the efficacy of the KD. Results (1) The efficacy rates for the KD at 3, 6, 12, and 18 months were 51.8%, 53.6%, 39.2%, and 23.2%, respectively. (2) The retention rates for the KD at 3, 6, 12 and 18 months were 100%, 69.6%, 41.1% and 23.2%, respectively. (3) There was no correlation between efficacy and gender, epilepsy onset age, the type of epilepsy syndrome, EEG improvement, or the number of antiseizure medications (ASMs), while cranial magnetic resonance imaging (MRI) abnormalities, KD duration, and KD initial age affected its efficacy at three months. Conclusion (1) KD therapy for refractory childhood epilepsy was effective and produced a high retention rate. (2) MRI abnormalities and the initial age and duration of KD influenced its short-term efficacy in RE children.

Efficacy and safety of a smartphone application‐based treatment of ketogenic diet in pediatric refractory epilepsy

“…Nevertheless, the response rate observed in our study was lower than that reported by other studies which ranged between 70% and 90% 22,23 . The retention rate of this study was 60.8% and 40.8% of the patients who had continued KD at 6 and 12 months, respectively, which was consistent with previous studies as well 24–26 . There was a statistically significant association between the retention rate and the outcome of seizures, so lack of compliance could be attributed to ineffectiveness or intolerance.…”

“…22,23 The retention rate of this study was 60.8% and 40.8% of the patients who had continued KD at 6 and 12 months, respectively, which was consistent with previous studies as well. [24][25][26] There was a statistically significant association between the retention rate and the outcome of seizures, so lack of compliance could be attributed to ineffectiveness or intolerance. A smartphone application was used in our follow-up process, which facilitates the communication between patients and the management team, improves communication efficiency, and increases patient compliance; this might be explained by the high retention rate (100%) at 3 months in this study; this retention rate is higher than that observed in the study conducted by Mei Yu et al 27 Our study had shown that the gender, the duration of seizure onset, the starting age of KD treatment, and BMI Z-score in children with epilepsy had no significant relationship with the effect, which was similar to previous findings.…”

“…A smartphone application was used in our follow-up process, which facilitates the communication between patients and the management team, improves communication efficiency, and increases patient compliance; this might be explained by the high retention rate (100%) at 3 months in this study; this retention rate is higher than that observed in the study conducted by Mei Yu et al 27 Our study had shown that the gender, the duration of seizure onset, the starting age of KD treatment, and BMI Z-score in children with epilepsy had no significant relationship with the effect, which was similar to previous findings. 26,28,29 The association between the blood ketone body and seizure control is widely divergent. Many researchers had suggested a relationship between the blood ketone body and seizure control, but some of them had found that the extent of ketones was not always proportionately correlated with better seizure outcomes.…”

Long‐term effectiveness and seizure recurrence risk factors of ketogenic diet for pediatric refractory epilepsy: Experience from a tertiary care center in China

“…Most previous studies examining the prognosis of patients who received KD focused primarily on seizure control outcomes. 4,[9][10][11] Our study demonstrates the efficacy of the KD in children with various types of drug-resistant epilepsy. Few studies have addressed the long-term outcomes of children on the KD and strategies for minimizing relapse occurrence.…”

“…Most previous studies examining the prognosis of patients who received KD focused primarily on seizure control outcomes 4,9–11 . Our study demonstrates the efficacy of the KD in children with various types of drug‐resistant epilepsy.…”