The use of the ketogenic diet as treatment for refractory epilepsy in the paediatric age

Introduction. Between 23% and 25% of epileptic children are refractory to antiepileptic drugs. In recent times there has been a renewed interest in the ketogenic diet as treatment in these patients who are not candidates for other therapeutic options. Aims. To evaluate the effectiveness and safety of treatment with the ketogenic diet in an important number of paediatric patients with refractory epilepsy in our centre and to determine whether the results obtained are consistent with others recently reported in the literature. Patients and methods. A retrospective review was conducted of the medical records of 41 children with refractory epilepsy treated with the ketogenic diet, mostly the Radcliffe II-type diet, between 1998 and 2011. Their median age on starting the diet was 3.92 years old. Results. At six months after beginning the diet, the number of crises was reduced by at least 50% in 36.84% of the sample (10.53% of the children reached a 90% reduction and 5.26% no longer suffered crises). Around 50% of those in the youngest age group responded positively. Some tolerable, transient side effects were experienced by 58.54% of the patients, consisting mainly in high levels of cholesterol and constipation; no variations in the anthropomorphic parameters were observed. Conclusions. The ketogenic diet is a good therapeutic alternative in cases of refractory epilepsy in the paediatric age. Moreover, the younger the child is on starting on the diet, the more likely he or she is to gain benefits from it. In general it is well tolerated. Regular check-ups with supervision of these patients' nutrition are of great importance.