The return to the ketogenic diet.: What role does it play in the treatment of refractory seizures of infancy?

Introduction. About one third of the patients with epilepsy are not satisfactorily controlled in spite of correct anticonvulsive treatment. Although the ketogenic diet has been used for refractory epilepsy since the 20s, over the past ten years it has been extensively used again. Objective. To review the effectiveness, tolerance and adverse effects in 12 paediatric patients who have been on this diet longer than three months. Patients and methods. We assessed 15 children, of whom only 12 are included in this review (5 boys and 7 girls). After initial joint evaluation by the neuropaediatrician and the Clinical Nutrition Unit the diet was started in hospital with a period of fasting (24-48 hours) until ketosis occurred. The diet was continued over three days before the child was sent home. In our centre we used a modified MCT diet, in which 30% of the energy was given in the form of MCT and 40% as natural fats. The effectiveness of the diet was found by comparing the daily number of seizures suffered by the patient before starting the diet with the number at different times later (1, 3, 6, 12, 18 months). Results. The median age when starting on the diet was 3 years and 5 months (range 18 months to 9 years). All had been diagnosed res having the Lennox-Gastaut syndrome, six having cryptogenic disease. Sir children had severe mental retardation. Sir months after starting the diet, half the children had over 50% reduction in seizures whilst a third had no seizures at all or had their frequency of occurrence reduced by over 90%. After one year three families had given up the diet, two because of its inefficacy in controlling the seizures. The diet was well-tolerated in all cases, with levels of ketonuria maintained at 2(+). Mild adverse effects were seen in only three patients and transient rise in the plasma cholesterol level in four children. Conclusions. The ketogenic diet is still an effective treatment for epilepsy, especially in patients in whom the drugs available have not led to improvements. Its excellent tolerance and few short-tem side-effects encourages its use in most cases of refractory epilepsy.