Abstracts

Rationale: The Ketogenic diet (KD) is advocated in the treatment of a wide range of childhood drug resistant epilepsy. We recently observed a dramatic response to KD in several patients with refractory focal epilepsy in the setting of recent worsening. We aimed to study whether this characteristic could be of interest regarding the indication of KD. Methods: We selected the 22 children diagnosed with symptomatic or cryptogenic focal epilepsy and treated with KD in our institution. We distinguished patients who had a recent seizure worsening, defined as an increase in seizure frequency during the last month resulting in nearly continuous seizure activity or status epilepticus. We administered the 4 to 1 ratio of lipid versus non lipid calories. KD was started during a 5 day admission to hospital. Clinical and biological follow-up comprised monitoring of glucose blood levels and ketosis. Patients were evaluated within the week preceding KD onset, one month after introduction of the KD and at the last visit on the diet. We compare the population characteristics of responders and non responders (etiology, age of onset of epilepsy, age of KD onset, the time lag between epilepsy and KD onset and recent worsening versus stable seizures frequency). We also compare the age at epilepsy onset, the age at KD onset, and the time lag from epilepsy onset to KD onset in the group of patients with recent worsening to that with stable epilepsy (Student T test). Results: There were 9 boys and 13 girls aged from 5 months to 18.5 years. Fifteen presented with symptomatic partial epilepsy and 7 with cryptogenic form. Ten patients had experienced a recent worsening of seizures with in 8 a negative functional impact (motor deficit, cognitive deterioration). Eleven patients (50%) were responders at one month with 7 seizure free. The median time lag to response was 3 days and 8/11 responders had responded during the first week. In the whole population, there was no relationship between the response at one month and the age at onset of epilepsy, the age of the KD onset or the epilepsy duration prior to the KD. Comparing the group of patients with recently increased seizure frequency with that of stable frequency, the number of responders was significantly higher in the first (7/10) than in the second (3/12) (p<0.01). All seizure free belonged to the first group. There was no significant difference between these two groups in terms of age the KD onset and time lag between epilepsy onset and the KD. In case of recent deterioration, all patients with negative functional impact dramatically improved. The duration of the diet ranged from 5 days to 12 months (mean 4.3 months, median 1.5 month). Among the 10 responders followed, 7 remained seizure free. No adverse events were reported in 45% of patients. Five had to stop the KD for early side effects. Conclusions: We suggest that a recent increase in seizure frequency in children with refractory focal epilepsy, particularly when associated with neurological regression due to seizure worsening, should be treated by KD combined with standard emergency AEDs.