Impact of two ketogenic diet types in refractory childhood epilepsy

Abstract

Background: Ketogenic diet (KD) refers to any diet in which food composition induces a ketogenic state of human metabolism.

Objective: To assess short- and long-term efficacy, safety, and tolerability of KD [classic KD and modified Atkins diet (MAD)] in childhood drug-resistant epilepsy (DRE) and to investigate the effect of KD on electroencephalographic (EEG) features of children with DRE.

Methods: Forty patients diagnosed with DRE according to International League Against Epilepsy were included and randomly assigned into classic KD or MAD groups. KD was initiated after clinical, lipid profile and EEG documentation, and regular follow-up was done for 24 months.

Results: Out of 40 patients with DRE, 30 completed this study. Both classic KD and MAD were effective in seizure control as 60% in classic KD group and 53.33% in MAD group became seizure free, and the remaining showed ≥50% seizure reduction. Lipid profile remained within acceptable levels throughout the study period in both groups. Adverse effects were mild and managed medically with an improvement of growth parameters and EEG during the study period.

Conclusions: KD is an effective and safe non-pharmacologic, non-surgical therapy for the management of DRE with a positive impact on growth and EEG.

Impact: Both common types of KD (classic KD and MAD) are effective for DRE, but unfortunately, nonadherence and dropout rates are frequent. High serum lipid profile (cardiovascular AE) is often suspected in children following a high-fat diet, but lipid profile remained in the acceptable level up to 24 months. Therefore, KD constitutes a safe treatment. KD had a positive impact on growth, despite inconsistent results of the KD's effect on growth. In addition to showing strong clinical effectiveness, KD also considerably decreased the frequency of interictal epileptiform discharges and enhanced the EEG background rhythm.

Fig. 1. Chalfont seizures severity scale 3 and 6 months after ketogenic diet.

Improvement by percentage in Chalfont Seizure Severity Scale (item by item) after 3 and 6 months of intervention.

Fig. 2

Changes in background rhythm slowing after 1, 3 and 6 months of ketogenic diet.

Fig. 3. Lipid profile of cases throughout the study (24 months).

a Simple line graph of median of serum HDL (mg/dL) in the studied groups. b Simple line graph of median of serum LDL (mg/dL) in the studied groups. c Simple line graph of median of serum total cholesterol (mg/dL) in the studied groups. d Simple line graph of median of serum triglycerides (mg/dL) in the studied groups.

Fig. 4. Weight and body mass index of cases throughout the study (24 months).

a Simple line graph of median (95% CI) of BMI SD in the studied groups. b Simple line graph of median (95% CI) of weight SD in the studied groups.