Efficacy of the ketogenic diet as a treatment option for epilepsy: meta-analysis.
The evidence base for the efficacy of the ketogenic diet was assessed among pediatric epileptic patients by application of a rigorous statistical meta-analysis. Nineteen studies from 392 abstracts met the inclusion criteria. The sample size was 1084 patients (mean age at initiation 5.78 +/- 3.43 years). The pooled odds ratio, using a random effects model, of treatment success (> 50% seizure reduction) among patients staying on the diet relative to those discontinuing the diet was 2.25 (95% confidence interval = 1.69-2.98). The reasons for diet discontinuation included < 50% seizure reduction (47.0%), diet restrictiveness (16.4%), and incurrent illness or diet side effects (13.2%). The results indicate that children with generalized seizures and patients who respond with > 50% seizure reduction within 3 months tend to remain on the diet longer. Although no class I or II studies have been published regarding the efficacy of the ketogenic diet, this meta-analysis shows that current observational studies reporting on the therapeutic effect of the ketogenic diet contain valuable statistical data. Future observational studies should aim for long-term follow-up, patient dropout analysis, and improved seizure type characterization.
Henderson
C Beth
CB
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA.
Filloux
Francis M
FM
Alder
Stephen C
SC
Lyon
Joseph L
JL
Caplin
Deirdre A
DA
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004032:Diet / Q000379:methods*; D050528:Diet, Carbohydrate-Restricted / Q000379:methods; D018753:Diet, Protein-Restricted / Q000379:methods; D004827:Epilepsy / Q000178:diet therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007662:Ketosis / Q000209:etiology / Q000378:metabolism*; D008297:Male; D016017:Odds Ratio; D010352:Patient Dropouts; D013997:Time Factors; D016896:Treatment Outcome