Abstracts

Rationale: Although ketogenic diets (KDs) have been used predominantly in children, there have been an increased number of centres providing this adjunct treatment for epilepsy. The Krembil Neuroscience Center at the Toronto Western Hospital was the first official Canadian centre to implement a clinic providing classical ketogenic diet and Modified Atkins diet (MAD) therapies to adults with epilepsy. Although the efficacy of KDs has been described in other countries, this study is the first analysis of ketogenic diets in an adult Canadian population, following the progression of MAD and KD patients. Methods: This is a retrospective study performed between January 2015 and September 2018. Forty-nine patients were followed at Toronto Western Hospital for ketogenic diet therapy.  Patients were either on diet therapy prior to their first visit (n=10) or initiated on a ketogenic diet during the course of their treatment (n=39).  All patients were seen in clinic, as applicable, at 3 months after initiating diet therapy, 6 months, 1 year and every year thereafter to follow their epilepsy progression.  Patients were in regular contact with a registered dietician by e-mail and phone to assist in maintaining or modifying their ketogenic diet.  Results: Thirty-eight percent of patients that were started on a diet experienced a >50% reduction in their seizure frequency, while 5% became seizure free.  However, looking at compliance and adherence we found that 49% of these patients discontinued the diet during the study with a median duration of 14 months on the diet. Sixty-one percent of all our patients experienced side effects, including weight loss and constipation.  We also found that 41% of patients perceived additional benefits to the diet outside of seizure control, the most common of which were milder seizures, improved cognition or alertness, faster postictal recovery and improved energy levels. Conclusions: Our study results parallel those of other adult centres and show that the classical ketogenic diet and MAD are effective and safe tools in treating epilepsy in a Canadian adult population. Serious adverse side effects were not seen in any patients during ketogenic diet therapy. Furthermore, beyond seizure control we found additional benefits to ketogenic diets which may be an important aspect of the patient experience and may play a role in diet adherence. Funding: This study was partly funded by the Toronto General & Western Hospital Foundation.