title: Decreased relative efficacy of the ketogenic diet for children with surgically approachable epilepsy.
abstract: OBJECTIVE
  In children with intractable, surgically approachable epilepsy, the ketogenic diet is often perceived as less efficacious than surgery.
  
  
  METHODS
  A retrospective chart review was performed of 554 children started on the ketogenic diet since 1994. Forty-five children were identified as surgical candidates, with at least 2 focal routine EEGs, ictal video-EEG, and corresponding focal neuroimaging findings, of whom 24 eventually had resective surgery and were followed subsequently. A comparison cohort group was also created of 45 children matched for age and seizure frequency that received the diet but were not surgical candidates (multifocal or generalized seizures).
  
  
  RESULTS
  Of the 24 children who received both dietary and surgical therapies, there was a higher likelihood after 6 months of both >90% seizure reduction (71% versus 17%) and seizure freedom (63% versus 0%) following surgery, both p < 0.0001. Similarly, the 45 cohort children who were not surgical candidates were more likely to be seizure-free (29% versus 13%, p = 0.041) and remained on the diet for shorter duration (10 months versus 18 months, p = 0.035) compared to the surgical group.
  
  
  CONCLUSIONS
  Children with surgically approachable epilepsy do respond to the diet, but are more likely to be seizure-free following surgery.
authors.affiliation: Department of Neurology and Pediatrics, The John M. Freeman Pediatric Epilepsy Center, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Stainman
authors.forename: Zahava
authors.initials: Z
authors.lastname: Turner
authors.forename: James E
authors.initials: JE
authors.lastname: Rubenstein
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kossoff
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D004569:Electroencephalography; D004827:Epilepsy / Q000178:diet therapy* / Q000601:surgery*; D004829:Epilepsy, Generalized / Q000178:diet therapy / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants