title: Dietary and medication adjustments to improve seizure control in patients treated with the ketogenic diet.
abstract: Unlike anticonvulsant drugs and vagus nerve stimulation, there are no guidelines regarding adjustments to ketogenic diet regimens to improve seizure efficacy once the diet has been started. A retrospective chart review was performed of 200 consecutive patients treated with the ketogenic diet at Johns Hopkins Hospital from 2007 to 2013. Ten dietary and supplement changes were identified, along with anticonvulsant adjustments. A total of 391 distinct interventions occurred, of which 265 were made specifically to improve seizure control. Adjustments led to >50% further seizure reduction in 18%, but only 3% became seizure-free. The benefits of interventions did not decrease over time. There was a trend towards medication adjustments being more successful than dietary modifications (24% vs 15%, P = .08). No single dietary change stood out as the most effective, but calorie changes were largely unhelpful (10% with additional benefit).
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jessica H
authors.initials: JH
authors.lastname: Selter
authors.affiliation: Division of Nutrition, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Zahava
authors.initials: Z
authors.lastname: Turner
authors.affiliation: Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Doerrer
authors.affiliation: Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA ekossoff@jhmi.edu.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kossoff
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D055423:Diet, Ketogenic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012640:Seizures / Q000178:diet therapy* / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: anticonvulsants; diet; epilepsy; ketogenic; ketosis