title: Ketogenic diet for the treatment of catastrophic epileptic encephalopathies in childhood.
abstract: The ketogenic diet for the treatment of refractory epileptic encephalopathies has been suggested as an early treatment option in very young children. The aim of the present study was to assess the efficacy and tolerability of the ketogenic diet in children younger than 5 years, all affected by different types of catastrophic childhood encephalopathies. The study group is composed of 38 children (22 males and 16 females), aged between 3 months and 5 years, affected by symptomatic partial epilepsy (6) and cryptogenic-symptomatic epileptic encephalopathies (32). Psychomotor delay-mental retardation was present in all of the patients: mild to moderate (9), severe (7), and profound (22). Cerebral palsy was present in 74% of the cases. Children were started on a 4:1 ketogenic diet as ketocal formula alone or supporting about the 80% of the daily caloric amount. Children poorly complying with ketocal milk were shifted to a classic 4:1 ketogenic diet. The average time (months +/- S.D.) on the diet was 10.3 +/- 7.4. All the children initiating the diet remained on it at 1 month and 35 of them (92%) at 3 months, 28 (73.7%) remained on it at 6 months, and 20 (52.7%) at 1 year. At 12-month follow-up, 11 children (28.9%) had a greater than 50% reduction of seizures and the other 9 (23.7%) were seizure-free. Adverse side effects were recorded in 25 of 38 patients (65.8%), including drowsiness, constipation, weight loss, vomiting, gastroesophageal reflux, fever, and hyperlipidemia. This report confirms that severe epileptic encephalopathies are much suitable for the ketogenic diet.
authors.affiliation: Clinic of Child Neuropsychiatry, Second University of Naples, Via Pansini, 5 80131 Naples, Italy. giangennaro.coppola@unina2.it
authors.forename: Giangennaro
authors.initials: G
authors.lastname: Coppola
authors.forename: Alberto
authors.initials: A
authors.lastname: Verrotti
authors.forename: Edoardo
authors.initials: E
authors.lastname: Ammendola
authors.forename: Francesca Felicia
authors.initials: FF
authors.lastname: Operto
authors.forename: Rita Della
authors.initials: RD
authors.lastname: Corte
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Signoriello
authors.forename: Antonio
authors.initials: A
authors.lastname: Pascotto
mesh_terms: D000367:Age Factors; D001921:Brain / Q000254:growth & development / Q000378:metabolism / Q000503:physiopathology; D001925:Brain Damage, Chronic / Q000178:diet therapy* / Q000209:etiology / Q000503:physiopathology; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology; D055423:Diet, Ketogenic / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D004334:Drug Administration Schedule; D004827:Epilepsy / Q000150:complications / Q000178:diet therapy* / Q000503:physiopathology; D005260:Female; D005526:Food, Formulated; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology; D008297:Male; D017063:Outcome Assessment, Health Care; D013997:Time Factors; D016896:Treatment Outcome