title: Ten-year single-center experience of the ketogenic diet: factors influencing efficacy, tolerability, and compliance.
abstract: OBJECTIVE
  To evaluate the efficacy, tolerability, and compliance of 3 ketogenic diets, the classical ketogenic diet, medium-chain triglyceride (MCT), and modified Atkins diet.
  
  
  METHODS
  A single-center, retrospective study of 48 children with intractable epilepsy receiving ketogenic diets from 2003 to 2012. Patient demographics, epilepsy history, nutritional management, and side effects were collated. Compliance and tolerability were assessed by recording reasons for diet modification and cessation. The value of potassium citrate supplementation for preventing nephrolithiasis was reviewed.
  
  
  RESULTS
  Median age at ketogenic diet initiation was 3.8 years (IQR: 2.3-7 years). The majority had intractable epilepsy, and 33 of the 48 children (69%) had epileptic encephalopathies. Three (6%) patients became seizure free, 35 (73%) reported <50%-90% reduction, and 10 (21%) had 0%-50% reduction during a 2-year period. Diet duration or ketogenic diet type did not predict reduction in seizures (P = .381; P = .272). Constipation (n = 31, 65%) was very common. Food refusal (n = 3, 6%) and poor parental compliance (n = 5, 10%) were common reasons cited for cessation. There were lower rates of side effects for modified Atkins diet. Diet cessation was greatest for MCT; however, 3 patients on MCT ceased therapy because adequate seizure control was achieved. Nephrolithiasis was reported in 1 patient before potassium citrate was used and 2 patients noncompliant with potassium citrate supplementation developed hypercalciuria.
  
  
  CONCLUSIONS
  The 3 ketogenic diets were comparably effective in seizure control and generally well-tolerated. Potassium citrate supplementation is an effective prophylactic supplement for the prevention of nephrolithiasis.
authors: School of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
authors: Cinthya
authors: C
authors: Wibisono
authors: Department of Dietetics and Nutrition, Sydney Children's Hospital, Randwick, New South Wales, Australia.
authors: Natalie
authors: N
authors: Rowe
authors: Department of Neurology, Sydney Children's Hospital, Randwick, New South Wales, Australia.
authors: Erin
authors: E
authors: Beavis
authors: Department of Dietetics and Nutrition, Sydney Children's Hospital, Randwick, New South Wales, Australia.
authors: Helen
authors: H
authors: Kepreotes
authors: Department of Nephrology, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, Medicine University of New South Wales, University of New South Wales, Sydney, New South Wales, Australia.
authors: Fiona E
authors: FE
authors: Mackie
authors: Department of Neurology, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, Medicine University of New South Wales, University of New South Wales, Sydney, New South Wales, Australia.
authors: John A
authors: JA
authors: Lawson
authors: Department of Neurology, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, Medicine University of New South Wales, University of New South Wales, Sydney, New South Wales, Australia. Electronic address: Michael.Cardamone@SESIAHS.HEALTH.NSW.GOV.AU.
authors: Michael
authors: M
authors: Cardamone
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D055423:Diet, Ketogenic / Q000379:methods*; D004827:Epilepsy / Q000178:diet therapy*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007223:Infant; D008297:Male; D010349:Patient Compliance; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome