title: Discontinuing the ketogenic diet in seizure-free children: recurrence and risk factors.
abstract: About 10% of children become seizure-free after initiation of the ketogenic diet, and typically stop the diet after 2 yr. A retrospective chart review was performed of all children who became seizure-free on the ketogenic diet at our institution since 1993 and then discontinued the diet. Of 557 children started on the diet since 1993, 66 (12%) discontinued the diet after a median of 2.1 yr due to seizure freedom; 92% were also medication-free. Thirteen (20%) had recurrence of their seizures at a median of 2.4 yr (range: 0-5.5 yr) after the diet was stopped. Seven (58%) became seizure-free a second time, four with anticonvulsant therapy. Four patients (6%) continue to have daily seizures despite both medication and dietary therapies. The presence of recent EEG epileptiform activity, abnormal MRI, lower initial seizure frequency, and tuberous sclerosis complex all significantly increased the likelihood of recurrence.
authors.affiliation: School of Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
authors.forename: Celina C
authors.initials: CC
authors.lastname: Martinez
authors.forename: Paula L
authors.initials: PL
authors.lastname: Pyzik
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kossoff
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D050528:Diet, Carbohydrate-Restricted; D004041:Dietary Fats / Q000008:administration & dosage / Q000378:metabolism*; D004044:Dietary Proteins / Q000008:administration & dosage / Q000378:metabolism; D018572:Disease-Free Survival; D004569:Electroencephalography / Q000706:statistics & numerical data; D004827:Epilepsy / Q000178:diet therapy* / Q000188:drug therapy / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007657:Ketone Bodies / Q000096:biosynthesis / Q000378:metabolism; D007662:Ketosis / Q000378:metabolism; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014402:Tuberous Sclerosis / Q000453:epidemiology / Q000378:metabolism
chemical_list: D000927:Anticonvulsants; D004041:Dietary Fats; D004044:Dietary Proteins; D007657:Ketone Bodies