title: The ketogenic diet in children, adolescents and young adults with refractory epilepsy: an Italian multicentric experience.
abstract: OBJECTIVE
  This collaborative study by three Italian groups of child neuropsychiatrists was carried on to evaluate the efficacy and safety of the classic 4:1 ketogenic diet as add-on treatment in refractory partial or generalized epilepsy in children, adolescents and young adults.
  
  
  METHODS
  We performed a prospective add-on study in 56 refractory epilepsy young patients (age 1-23 years, mean 10.4 years), all with both symptomatic and cryptogenic, generalized or partial epilepsies. Child neuropsychiatrists worked with nutritional team for sample selection and patients management. The ketogenic diet was added to the baseline antiepileptic drugs and the efficacy was rated according to seizure type and frequency. During treatment, seizure frequency, side effects, urine and blood ketone levels and other parameters were systematically evaluated.
  
  
  RESULTS
  Patients have been treated for 1-18 months (mean 5 months). A >50% reduction in seizure frequency was gained in 37.5 and 26.8% of patients after 3 and 6 months, respectively, at 12 months, this number fell by 8.9%. No significant relationship between diet efficacy and seizure or epilepsy type, age at diet onset, sex and etiology of epilepsy was noted. Nevertheless, it seems noteworthy that 64% of our patients with neuronal migration disorders improved on this diet. Adverse effects occurred, mainly in the first weeks of treatment, in 32 patients (57.1%), but were generally mild and transient. In seven patients (12.5%) it was possible to withdraw one to two AED after 3-4 months on ketogenic diet.
  
  
  CONCLUSIONS
  This initial experience with the ketogenic diet was effective in difficult-to-treat patients with partial and generalized epilepsies, though its efficacy dropped significantly by 9-12 months.
authors.affiliation: Clinic of Child Neuropsychiatry, Second University of Naples, Via Pansini 5, 80131, Naples, Italy. giangennaro.coppola@unina2.it
authors.forename: Giangennaro
authors.initials: G
authors.lastname: Coppola
authors.forename: Pierangelo
authors.initials: P
authors.lastname: Veggiotti
authors.forename: Raffaella
authors.initials: R
authors.lastname: Cusmai
authors.forename: Simona
authors.initials: S
authors.lastname: Bertoli
authors.forename: Simonetta
authors.initials: S
authors.lastname: Cardinali
authors.forename: Carlo
authors.initials: C
authors.lastname: Dionisi-Vici
authors.forename: Mirella
authors.initials: M
authors.lastname: Elia
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Lispi
authors.forename: Chiara
authors.initials: C
authors.lastname: Sarnelli
authors.forename: Anna
authors.initials: A
authors.lastname: Tagliabue
authors.forename: Caterina
authors.initials: C
authors.lastname: Toraldo
authors.forename: Antonio
authors.initials: A
authors.lastname: Pascotto
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000178:diet therapy* / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D007657:Ketone Bodies / Q000096:biosynthesis* / Q000378:metabolism / Q000627:therapeutic use; D007662:Ketosis / Q000139:chemically induced / Q000378:metabolism*; D008297:Male; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D007657:Ketone Bodies