title: The ketogenic diet improves recently worsened focal epilepsy.
abstract: OBJECTIVE
  We observed a dramatic response to the ketogenic diet in several patients with highly refractory epilepsy whose seizure frequency had recently worsened. This study aimed to identify whether this characteristic was a useful indication for the ketogenic diet.
  
  
  METHODS
  From the 70 patients who received the ketogenic diet during a 3-year period at our institution, we retrospectively selected patients with focal epilepsy. There were 22 children, 13 females and nine males, aged from 5 months to 18 years 6 months (mean 6y 9mo, SD 5y 11mo). Fifteen had symptomatic and seven had cryptogenic focal epilepsy. Seizure frequency 1 week before initiating the ketogenic diet was compared with that at 1 month and at the last visit on the diet.
  
  
  RESULTS
  Eleven patients were responders (defined as reduction of seizures by more than 50%) at 1 month. Responders were higher (p=0.046) in the group with a recent worsening of seizures than in those with stable seizure frequency. Seven patients were still seizure-free at 6 months on the diet. Tolerability was excellent in 10 patients. Five patients stopped the diet because of early side effects.
  
  
  CONCLUSIONS
  The ketogenic diet may be a valuable therapeutic option for children with pharmacoresistant focal epilepsy, particularly those with a recent deterioration of seizure control and neurological status. Because of its rapid effect, the ketogenic diet may be a useful support to intravenous emergency drugs in such a situation.
authors.affiliation: Henri-Gastaut Hospital, Marseille, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Villeneuve
authors.forename: Florence
authors.initials: F
authors.lastname: Pinton
authors.forename: Nadia
authors.initials: N
authors.lastname: Bahi-Buisson
authors.forename: Olivier
authors.initials: O
authors.lastname: Dulac
authors.forename: Catherine
authors.initials: C
authors.lastname: Chiron
authors.forename: Rima
authors.initials: R
authors.lastname: Nabbout
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D055423:Diet, Ketogenic / Q000379:methods*; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000178:diet therapy* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000927:Anticonvulsants