The Turkish Journal of Pediatrics 2022 , Vol 64 , Num 2
The effectiveness of the ketogenic diet in drug-resistant childhood epilepsy
Ünsal Yılmaz 1 ,Selvinaz Edizer 1 ,Zeynep Akışin 2 ,Melis Köse 3 ,Yiğithan Güzin 1 ,Gürkan Gürbüz 4 ,Bahar Toklu Baysal 5 ,Serdar Sarıtaş 1 ,Serdar Pekuz 1 ,Hatice Hilal Kırkgöz 1 ,Merve Yavuz 1 ,Aycan Ünalp 1
1 Departments of Pediatric Neurology, University of Health Sciences Turkey, Dr. Behçet Uz Children’s Education and Research Hospital, İzmir
2 Departments of Nutrition and Dietetics, University of Health Sciences Turkey, Dr. Behçet Uz Children’s Education and Research Hospital, İzmir
3 Department of Pediatric Metabolism and Nutrition, İzmir Katip Çelebi University, Izmir
4 Department of Pediatric Neurology, Tekirdağ Namık Kemal University Medical Faculty Tekirdağ
5 Department of Pediatric Neurology, T. C. Ministry of Health Uşak Education and Research Hospital, Uşak, Turkey
DOI : 10.24953/turkjped.2021.4 Background. We aimed to investigate the effectiveness of ketogenic diet (KD) in children with various types of refractory epilepsy.

Methods. A total of 91 children (49 females) aged 3 to 193 months (median, 52 months) with drug resistant epilepsy who received KD treatment for at least 12 months were enrolled in the study. Seizure frequency, adherence to diet, reason for discontinuation of KD, and adverse effects were recorded. Response was defined as ≥50% improvement in seizure frequency compared to baseline. We also searched for influences of different variables on the outcome.

Results. Intent-to-treat analysis revealed an improvement in seizure frequency for ≥50% in 73.6%, 80.2%, 75.8%, 73.6%, and 70.3% of patients at month-1, -3, -6, -9, and month-12, respectively. Overall, 32 (35.2%) patients remained seizure-free at month-12. There was no significant differences between responders and nonresponders in terms of age at onset of epilepsy, age at onset of KD, gender, or etiology. Mild hyperlipidemia was associated with a higher response rate. At the last follow-up (median: 20 months), 38 (41.8%) patients were still maintained on KD. While 15.4% of patients completed the diet with a success in seizure control, remainder discontinued KD due to lack of efficacy (23.1%), non-adharence to diet (11%), intercurrent infection (4.4%), adverse effects (3.3%), and death (1.1%).

Conclusion. Ketogenic diet treatment appears to be effective in about two-thirds of children with various types of drug-resistant epilepsy, including one-third remaining seizure free. Mild hyperlipidemia seems to be associated with a higher response rate. Discontinuation of KD is mostly due to lack of efficacy or nonadherence, and rarely side effects. Keywords : ketogenic diet, drug-resistant epilepsy, effectiveness, tolerability

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