Ketogenic diet for infantile spasms refractory to first-line treatments: an open prospective study.
Ketogenic diet (KD) is an efficient treatment for refractory epilepsy including infantile spasms (IS). We evaluated the effect of a KD to treat IS as a third-line treatment, after vigabatrin (VGB) and steroids. We evaluated the efficacy and the tolerability of KD in IS using the rate of seizure-free patients at 1 month.


METHODS
We conducted an open study using the data from a prospective database of two French child neurology departments (Amiens & Robert Debré-Paris, France) over a three-year period. All the patients followed the KD for 6 months. The addition of an antiepileptic drug was allowed after 1 month of KD in the non-seizure-free patients.


RESULTS
17 patients were treated by KD for IS. The KD was initiated at the mean age of 9.4±1.1 months. After 1 month with KD, 6/17 (35%) patients were seizure free while 11/17 (65%) were seizure-free after the third month. However, an additional antiepileptic drug (felbamate or topiramate) was given to all patients that were not seizure-free under KD. The KD was well tolerated.


CONCLUSIONS
Our responder rate is similar to previous studies despite an early use (before 1-year-old) and the use of KD after VGB and steroids. The KD was well-tolerated in this population of young infants. Felbamate leads to an increase in the responder rate after the use of KD.
APHP, Hôpital Robert Debré, Service de Neurologie Pédiatrique, Paris, France.
Maria Elisa
ME
Pires
Adina
A
Ilea
Emilie
E
Bourel
Vanina
V
Bellavoine
Dana
D
Merdariu
Patrick
P
Berquin
Stéphane
S
Auvin
D015331:Cohort Studies; D055423:Diet, Ketogenic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D013036:Spasms, Infantile / Q000175:diagnosis* / Q000178:diet therapy*; D016896:Treatment Outcome