title: Long-term outcome and tolerability of the ketogenic diet in drug-resistant childhood epilepsy--the Austrian experience.
abstract: OBJECTIVE
  To evaluate the long-term efficacy/tolerability of the ketogenic diet (KD) in paediatric drug-resistant epilepsies.
  
  
  METHODS
  Data from children who were treated between 1999 and 2008 and had continuous follow-up of at least 6 months after initiation of the KD were analysed retrospectively. Response was defined as > or = 50% seizure reduction. Treatment effects on EEG, developmental outcome and the "outcome-predictive" value of various clinical factors were also assessed.
  
  
  RESULTS
  50 children (22 boys; mean age 4.5 years+/-3.55) were included. Mean follow-up was 3.93+/-2.95. 50% of the patients were responders, 48% of them became seizure free. 50% were non-responders, 20% of them deteriorated. In responders, EEG background activity improved significantly (p=0.014) and a significantly lower rate of epileptic discharges (p=0.009) was seen after 6 months. In addition, neurological examination findings demonstrated significant developmental progress (p=0.038). Favourable treatment outcome was associated with a shorter disease duration (p=0.025) and generalised tonic clonic seizures (p=0.059). No further significant outcome predictors were detected. However, response was 44% in patients with infantile spasms, 62.5% in those with Dravet syndrome and 50% in Lennox-Gastaut-syndrome. Side effects occurred in 28%, but discontinuation of the KD was not required in any case. They most often observed with concomitant topiramate (p=0.001) and valproate (p=0.046).
  
  
  CONCLUSIONS
  Despite the retrospective nature of the study and the inhomogeneous patient sample, we found good long-term effects of the KD on seizure frequency, EEG and neurological development.
authors.affiliation: Department of Paediatrics, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Wien, Vienna, Austria.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Dressler
authors.forename: Benjamin
authors.initials: B
authors.lastname: Stöcklin
authors.forename: Eva
authors.initials: E
authors.lastname: Reithofer
authors.forename: Franz
authors.initials: F
authors.lastname: Benninger
authors.forename: Michael
authors.initials: M
authors.lastname: Freilinger
authors.forename: Erwin
authors.initials: E
authors.lastname: Hauser
authors.forename: Edith
authors.initials: E
authors.lastname: Reiter-Fink
authors.forename: Rainer
authors.initials: R
authors.lastname: Seidl
authors.forename: Petra
authors.initials: P
authors.lastname: Trimmel-Schwahofer
authors.forename: Martha
authors.initials: M
authors.lastname: Feucht
mesh_terms: D001317:Austria; D002648:Child; D002675:Child, Preschool; D055423:Diet, Ketogenic; D004351:Drug Resistance; D004569:Electroencephalography; D004827:Epilepsy / Q000178:diet therapy*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013995:Time; D016896:Treatment Outcome