title: Long-term use of the ketogenic diet in the treatment of epilepsy.
abstract: Long-term outcomes of the ketogenic diet in the treatment of epilepsy have not previously been reported. A retrospective chart review of children treated with the ketogenic diet for more than 6 years at the Johns Hopkins Hospital was performed. The response was documented at clinic visits and by telephone contacts; laboratory studies were obtained approximately every 6 to 12 months. Satisfaction and tolerability were assessed by means of a brief parental telephone questionnaire. In all, 28 patients (15 males, 13 females), currently aged 7 to 23 years, were identified. The median baseline seizure frequency per week at diet onset was 630 (range 1-1400). Diet duration ranged from 6 to 12 years; 19 remain on the diet currently. After 6 years or more, 24 children experienced a more than 90% decrease in seizures, and 22 parents reported satisfaction with the diet's efficacy. Ten children were at less than the 10th centile for height at diet initiation; this number increased to 23 at the most recent follow-up (p=0.001). Kidney stones occurred in seven children and skeletal fractures in six. After 6 years or more the mean cholesterol level was 201mg/dl, high-density lipoprotein was 54mg/dl, low-density lipoprotein was 129mg/dl, and triglycerides were 97mg/dl. Efficacy and overall tolerability for children are maintained after prolonged use of the ketogenic diet. However, side effects, such as slowed growth, kidney stones, and fractures, should be monitored closely.
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Darcy K
authors.initials: DK
authors.lastname: Groesbeck
authors.forename: Renee M
authors.initials: RM
authors.lastname: Bluml
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kossoff
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004035:Diet Therapy / Q000009:adverse effects; D004827:Epilepsy / Q000178:diet therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007662:Ketosis; D008297:Male; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome