Efficacy of the ketogenic diet for the treatment of refractory epilepsy in children

Background. While in the Anglo-American countries the ketogenic diet (KD) has shown to be efficient in the treatment of refractory epilepsy, an attempt of evaluation in Germany (Workshop 2000 in Essen) showed an unfavorable result (0% seizure-free, seizure reduction >50% in only 16%). Objective. As the evaluation in Germany (Workshop 2000 in Essen) did not include the results of our patients, we present the retrospective evaluation of the efficacy of the KD in our patients with refractory epilepsy. Patients and Methods. We report 24 patients with refractory epilepsy who have been treated with the KD between February 1997 and January 2002.When the KD was started median (range) of age was 6.0 years (0.8-13.2), number of antiepileptic drugs used previously was 7 (3-13), time since onset of epilepsy 53 months (5-159) and seizure frequency 140/week (250 myoclonic seizures/day up to 1 status epilepticus/month). 13 patients had symptomatic, 8 patients cryptogenic and 3 patients idiopathic epilepsy. Results. In 2 patients the KD was stopped during initiation due to side effects (vomiting, sleepiness). Reduction of seizures >50% was achieved in 59% of the patients, 2/22 (9%) have become seizure-free for 22 months respectively 3.8 years. Seizure reduction >90% was achieved in further 5/22 patients (23%) and seizure reduction between 50-90% in further 6/22 patients (27%). At the time of evaluation the responders with seizure reduction >50% have been on the KD for 116 weeks (13-221). There was no significant difference between responders and nonresponders regarding the number of antiepileptic drugs used before the KD, the age and time since onset of epilepsy when the KD was started nor the types of seizures. Conclusion. The Ketogenic diet is efficient in reducing seizure frequency in children with refractory epilepsy.