Abstracts

Rationale: The ketogenic diet has been used for many years in the treatment of drug resistant epilepsy in children but to date there has been no randomised controlled trial examining efficacy of the diet against no treatment, or comparing classical and medium chain triglyceride (MCT) dietary protocols. Methods: 145 children were randomised to receive either the classical or MCT ketogenic diet, either immediately or after a 3-month delay (control group). Early discontinuations were recorded. Seizure frequency was assessed after 3 months, compared to that of controls. The efficacy of the two diets was compared.Results: 3-month seizure data is available for 94 diet children (45 classical, 49 MCT) and 49 controls. The mean percentage of baseline seizures was significantly lower in the 94 diet children (68%) than in the controls (137%, p<0.001), but there was no difference between the classical or MCT diets (67% and 69% respectively, p=0.93). 39 of the 94 diet children had greater than 50% seizure reduction (41%), compared to 4 controls (8%) (p<0.001). 7 of the diet group had greater than 90% seizure reduction (8%), compared to no controls (p<0.1). There were no significant differences in efficacy between the two diet types. When response was reviewed by epilepsy syndrome numbers were small; the reduced mean percentage of baseline seizures was particularly striking for Lennox Gastaut syndrome (50%), myoclonic absence (55%), myoclonic astatic (58%), and unspecified myoclonic epilepsy (59%). 20 children never started the diet, 25 discontinued before 3 months, and 6 did not provide data. Of the 25 that discontinued, 5 reported increased seizures (4 classical, 1 MCT diet) and 20 reported dietary intolerance (6 classical, 14 MCT diet, p<0.01; parental unhappiness 6, vomiting 1, diarrhoea 3, constipation 1, extreme drowsiness 1, problems with texture 1, food refusal 7). Conclusions: Results from the first randomised controlled trial of the ketogenic diet strongly support its use in childhood epilepsy. Classical and MCT dietary protocols are comparable in efficacy after 3 months.