A randomized trial of classical and medium-chain triglyceride ketogenic diets in the treatment of childhood epilepsy.
OBJECTIVE
To conduct the first randomized trial on classical and medium-chain triglyceride (MCT) versions of the ketogenic diet, examining efficacy and tolerability after 3, 6, and 12 months.


METHODS
One hundred forty-five children with intractable epilepsy were randomized to receive a classical or an MCT diet. Seizure frequency was assessed after 3, 6, and 12 months. Treatment withdrawals were documented. Tolerability was assessed by questionnaire, and blood ketone levels were measured.


RESULTS
Of the 61 children who started a classical diet and the 64 who started an MCT diet, data from 94 were available for analysis: 45 classical and 49 MCT. After 3, 6, and 12 months there were no statistically significant differences in mean percentage of baseline seizures between the two groups (3 months: classical 66.5%, MCT 68.9%; 6 months: classical 48.5%, MCT 67.6%; 12 months: classical 40.8%, MCT 53.2%; all p > 0.05). There were no significant differences between groups in numbers achieving greater than 50% or 90% seizure reduction. Serum acetoacetate and beta-hydroxybutyrate levels at 3 and 6 months were significantly higher in children on the classical diet (p < 0.01); this was the case at 12 months for acetoacetate. There were no significant differences in tolerability except increased reports in the classical group of lack of energy after 3 months and vomiting after 12 months.


CONCLUSIONS
This study has shown classical and MCT ketogenic diet protocols to be comparable in efficacy and tolerability; both ways of implementing the diet have their place in the treatment of childhood epilepsy.
Neal
Elizabeth G
EG
UCL-Institute of Child Health & Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom. l.neal@ich.ucl.ac.uk
Chaffe
Hannah
H
Schwartz
Ruby H
RH
Lawson
Margaret S
MS
Edwards
Nicole
N
Fitzsimmons
Georgiana
G
Whitney
Andrea
A
Cross
J Helen
JH
D000293:Adolescent; D000367:Age Factors; D000927:Anticonvulsants / Q000145:classification / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D055423:Diet, Ketogenic / Q000379:methods*; D004827:Epilepsy / Q000178:diet therapy* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000145:classification / Q000627:therapeutic use*
D000927:Anticonvulsants; D014280:Triglycerides