title: [Ketogenic diet as antiepileptic therapy: a description of the clinical experience and the multidisciplinary approach at the metabolic-neurogenetic clinic at the Wolfson Medical Center].
abstract: The ketogenic diet, built on a menu that includes a high fat content and low protein and carbohydrate percentages, constitutes an alternative therapy for children with refractory epilepsy. This study describes our clinical experience with the diet, its efficacy, and the adverse effects associated with this treatment modality, which is mainly indicated in patients who do not respond to conventional antiepileptic drugs (AEDs). We place particular emphasis on our multidisciplinary approach, which includes physicians, nurses, social workers, and dieticians. A chart review was performed on all pediatric patients who received the diet in our clinic between 1998 and 2003. We recorded the patients' demographic data, the age at epilepsy onset, the age of the patient at the time the diet was started, the characteristics of the epilepsy, the seizure frequency, the AEDs prior to and during the diet, the patient and family compliance, and the adverse effects.
  
  
  RESULTS
  Ten patients were treated. The youngest patient was 8 months old and the oldest was 19 years old at the onset of the diet. Eight children suffered from a well-defined epileptic syndrome. All children had frequent seizures and received between 2 and 9 AEDs prior to the diet. The duration of the diet ranged between 6 weeks and two and a half years. Seven patients experienced over 50% seizure reduction while on the diet. However, total seizure control was not attained in any patient. Adverse effects were minimal. All the patients complied with this rigid diet in a good or excellent manner. Furthermore, we also observed an improvement in the degree of alertness, learning skills, and developmental milestones in most of the children. The diet failed to provide satisfactory seizure control or improvement in the well-being of 3 patients. In conclusion, the ketogenic diet is an effective therapeutic alternative for children with refractory epilepsy, irrespective of the patient's age, gender or disease duration. We attribute our therapeutic success with the diet to the multidisciplinary approach carried out in our clinic.
authors.affiliation: Metabolic-Neurogenetic Clinic, Pediatric Neurology Unit, Wolfson Medical Center, Holon.
authors.forename: Mira
authors.initials: M
authors.lastname: Ginzberg
authors.forename: Nathan
authors.initials: N
authors.lastname: Watemberg
authors.forename: Anat
authors.initials: A
authors.lastname: Levi
authors.forename: Aharon
authors.initials: A
authors.lastname: Gabai
authors.forename: Andreea
authors.initials: A
authors.lastname: Nissenkorn
authors.forename: Luba
authors.initials: L
authors.lastname: Blumkin
authors.forename: Chana
authors.initials: C
authors.lastname: Vinkler
authors.forename: Dorit
authors.initials: D
authors.lastname: Lev
authors.forename: Tally
authors.initials: T
authors.lastname: Lerman-Sagie
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000178:diet therapy* / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007659:Ketones; D010348:Patient Care Team; D012189:Retrospective Studies; D012640:Seizures
chemical_list: D000927:Anticonvulsants; D007659:Ketones