Long-term outcome and tolerability of the ketogenic diet in drug-resistant childhood epilepsy-The Austrian experience

被引:75
作者
Dressler, Anastasia [1 ]
Stoecklin, Benjamin [1 ,3 ]
Reithofer, Eva [1 ]
Benninger, Franz [2 ]
Freilinger, Michael [1 ]
Hauser, Erwin [1 ]
Reiter-Fink, Edith [1 ]
Seidl, Rainer [1 ]
Trimmel-Schwahofer, Petra [1 ]
Feucht, Martha [1 ]
机构
[1] Med Univ Vienna, Dept Paediat, A-1090 Vienna, Austria
[2] Med Univ Vienna, Dept Child & Adolescent Psychiat, A-1090 Vienna, Austria
[3] Univ Childrens Hosp Basel, Dept Neuropaediat, Basel, Switzerland
来源
SEIZURE-EUROPEAN JOURNAL OF EPILEPSY | 2010年 / 19卷 / 07期
关键词
Ketogenic diet; Childhood; Epilepsy; ANTIEPILEPTIC DRUGS; EFFICACY; CHILDREN; SAFETY;
D O I
10.1016/j.seizure.2010.06.006
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Purpose: To evaluate the long-term efficacy/tolerability of the ketogenic diet (KD) in paediatric drug-resistant epilepsies. Methods: Data from children who were treated between 1999 and 2008 and had continuous follow-up of at least 6 months after initiation of the KD were analysed retrospectively. Response was defined as >= 50% seizure reduction. Treatment effects on EEG, developmental outcome and the "outcome-predictive" value of various clinical factors were also assessed. Results: 50 children (22 boys; mean age 4.5 years +/- 3.55) were included. Mean follow-up was 3.93 +/- 2.95. 50% of the patients were responders, 48% of them became seizure free. 50% were non-responders, 20% of them deteriorated. In responders, EEG background activity improved significantly (p = 0.014) and a significantly lower rate of epileptic discharges (p = 0.009) was seen after 6 months. In addition, neurological examination findings demonstrated significant developmental progress (p = 0.038). Favourable treatment outcome was associated with a shorter disease duration (p = 0.025) and generalised tonic clonic seizures (p = 0.059). No further significant outcome predictors were detected. However, response was 44% in patients with infantile spasms, 62.5% in those with Dravet syndrome and 50% in Lennox-Gastaut-syndrome. Side effects occurred in 28%, but discontinuation of the KD was not required in any case. They most often observed with concomitant topiramate (p = 0.001) and valproate (p = 0.046). Conclusion: Despite the retrospective nature of the study and the inhomogeneous patient sample, we found good long-term effects of the KD on seizure frequency, EEG and neurological development. (C) 2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:404 / 408
页数:5
相关论文
共 41 条
[1]  
[Anonymous], 1981, Epilepsia, V22, P489
[2]   PROPOSAL FOR REVISED CLASSIFICATION OF EPILEPSIES AND EPILEPTIC SYNDROMES [J].
不详 .
EPILEPSIA, 1989, 30 (04) :389-399
[3]   Selenium deficiency associated with cardiomyopathy: A complication of the ketogenic diet [J].
Bergqvist, AGC ;
Chee, CM ;
Lutchka, L ;
Rychik, J ;
Stallings, VA .
EPILEPSIA, 2003, 44 (04) :618-620
[4]   Ketogenic diet in patients with Dravet syndrome [J].
Caraballo, RH ;
Cersósimo, RO ;
Sakr, D ;
Cresta, A ;
Escobal, N ;
Fejerman, N .
EPILEPSIA, 2005, 46 (09) :1539-1544
[5]  
Caraballo RH, 2006, EPILEPTIC DISORD, V8, P151
[6]   Plasma free carnitine in epilepsy children, adolescents and young adults treated with old and new antiepileptic drugs with or without ketogenic diet [J].
Coppola, G ;
Epifanio, G ;
Auricchio, G ;
Federico, RR ;
Resicato, G ;
Pascotto, A .
BRAIN & DEVELOPMENT, 2006, 28 (06) :358-365
[7]   Type 1 diabetes and epilepsy: Efficacy and safety of the ketogenic diet [J].
Dressler, Anastasia ;
Reithofer, Eva ;
Trimmel-Schwahofer, Petra ;
Klebermasz, Katrin ;
Prayer, Daniela ;
Kasprian, Gregor ;
Rami, Birgit ;
Schober, Edith ;
Feucht, Martha .
EPILEPSIA, 2010, 51 (06) :1086-1089
[8]  
Engel J., 1998, EPILEPSY COMPREHENSI
[9]   Elevated polyunsaturated fatty acids in blood serum obtained from children on the ketogenic diet [J].
Fraser, DD ;
Whiting, S ;
Andrew, RD ;
Macdonald, EA ;
Musa-Veloso, K ;
Cunnane, SC .
NEUROLOGY, 2003, 60 (06) :1026-1029
[10]   The efficacy of the ketogenic diet - 1998: A prospective evaluation of intervention in 150 children [J].
Freeman, JM ;
Vining, EPG ;
Pillas, DJ ;
Pyzik, PL ;
Casey, JC ;
Kelly, MT .
PEDIATRICS, 1998, 102 (06) :1358-1363