Anastasia
Dressler, Petra Trimmel-Schwahofer, Eva Reithofer, Gudrun Gröppel, Angelika
Mühlebner, Sharon Samueli, Viktoria Grabner, Klaus Abraham, Franz Benninger,
Martha Feucht. The ketogenic diet in
infants – Advantages of early use. Epilepsy Research, online 07/28/2015
Abstract
Objective
To evaluate the efficacy and safety
of the ketogenic diet (KD) in infants (<1.5 years of age) compared with
older children.
Methods
Patients with complete follow-up
data of ≥3 months after initiation of the KD were analyzed retrospectively.
Infants <1.5 years at initiation of the KD (Group A) were compared with
children >1.5 years (Group B).
Results
127 children were screened, 115
(Group A: 58/Group B: 57) were included. There were no significant differences
between groups with respect to responder rates (63.8% vs. 57.9% at 3 months),
but more infants became seizure free (34.5% vs. 19% at 3 months; 32.7% vs.
17.5% at 6 and 12 months). This result remained stable also after termination
of the KD (30.6% vs. 3.9% at last follow-up) (p = 0.000). Looking at
infants <9 months of age separately (n = 42), this result was even
stronger with significantly more infants being seizure free at 6 and at 12
months (p = 0.005, p = 0.014, respectively). In addition, a
significantly higher number of infants remained seizure free in the long-term (p = 0.001).
No group differences between infants
and children with respect to safety were observed. Overall 52/115 patients
(45.21%) reported side effects, but withdrawal of the KD was only necessary in
one infant. Acceptance of the KD was better in infants compared with children
at 3 months (0 vs. 14, p = 0.000), but became difficult when solid food
was introduced (16 vs. 14; n.s.).
Significance
According to our results, the KD is
highly effective and well tolerated in infants with epilepsy. Seizure freedom
is more often achieved and maintained in infants. Acceptance of the diet is
better before the introduction of solid food. Therefore, we recommend the early
use of the KD during the course of epilepsy.
Methods
- Patients with complete follow-up data of ≥3 months after initiation of the KD were analyzed retrospectively.
- Infants <1.5 years at initiation of the KD (Group A) were compared with children >1.5 years (Group B).
Results
- 127 children were screened, 115 (Group A: 58/Group B: 57) were included.
- There were no significant differences between groups with respect to responder rates (63.8% vs. 57.9% at 3 months), but more infants became seizure free (34.5% vs. 19% at 3 months; 32.7% vs. 17.5% at 6 and 12 months).
- This result remained stable also after termination of the KD (30.6% vs. 3.9% at last follow-up) (p = 0.000).
- Looking at infants <9 months of age separately (n = 42), this result was even stronger with significantly more infants being seizure free at 6 and at 12 months (p = 0.005, p = 0.014, respectively).
- In addition, a significantly higher number of infants remained seizure free in the long-term (p = 0.001).
- No group differences between infants and children with respect to safety were observed.
- Overall 52/115 patients (45.21%) reported side effects, but withdrawal of the KD was only necessary in one infant.
- Acceptance of the KD was better in infants compared with children at 3 months (0 vs. 14, p = 0.000), but became difficult when solid food was introduced (16 vs. 14; n.s.).
Vehmeijer FO, van der Louw EJ, Arts WF, Catsman-Berrevoets CE, Neuteboom RF. Can we predict efficacy of the ketogenic diet in children with refractory
ReplyDeleteepilepsy? Eur J Paediatr Neurol. 2015 Jul 9.
Abstract
BACKGROUND:
The ketogenic diet (KD) can be effective in reducing seizures in children. Predictors of success have not been identified yet.
AIMS:
To evaluate efficacy of KD treatment and to search for child- or diet-related factors that can predict its efficacy at 12 months follow-up. In addition we wish to determine the usefulness of a 3-month KD trial period.
METHODS:
Single center retrospective study in a university paediatric hospital of children with refractory epilepsy in which the KD had been initiated. Patient and diet characteristics as well as seizure reduction data were obtained from medical records and parental review. Efficacy of the KD was defined as ≥ 50% seizure reduction. Variables were evaluated in their relation to a successful treatment at three and 12 months after diet initiation.
RESULTS:
During a 9.5-year period, the KD was initiated in 59 children with refractory epilepsy. Twenty-four children were still on the KD after 12 months, and 21 experienced ≥50% seizure reduction. Success of the KD at three months was significantly related to a successful response to KD treatment at 12 months (p < 0.001).
CONCLUSIONS:
The KD can be an effective treatment in reducing seizures in children with refractory epilepsy. No significant relationships between variables and efficacy at 12 months were revealed. Children with a successful response at 3 months were significantly more likely to achieve success at 12 months of KD treatment.