The ketogenic diet in children, adolescents and young adults with refractory epilepsy: an Italian multicentric experience.
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.
Coppola
Giangennaro
G
Clinic of Child Neuropsychiatry, Second University of Naples, Via Pansini 5, 80131, Naples, Italy. giangennaro.coppola@unina2.it
Veggiotti
Pierangelo
P
Cusmai
Raffaella
R
Bertoli
Simona
S
Cardinali
Simonetta
S
Dionisi-Vici
Carlo
C
Elia
Mirella
M
Lispi
Maria Luisa
ML
Sarnelli
Chiara
C
Tagliabue
Anna
A
Toraldo
Caterina
C
Pascotto
Antonio
A
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
D007657:Ketone Bodies