Abstracts

RATIONALE: The ketogenic diet has been utilized mainly in children with refractory epilepsy. However, its efficacy and safety in adults in still uncertain. This study further evaluates the utility of the ketogenic in adults with refractory epilepsy.
METHODS: All patients (pts)with refractory epilepsy (any type) who were initiated on a 4:1 ratio (fats:carbohydrates/protein in calories) ketogenic diet were analyzed. Maximal duration of the diet was predetermined (24 months). The following data (at baseline and last follow-up) were reviewed: 1) seizure frequency, 2) metabolic and nutritional laboratory data and EEG, 3) compliance, 4) weight, and 5) reason for discontinuation. Side effects and cognitive effects were also noted.
RESULTS: 19 pts with refractory epilepsy (37% partial, 58% symptomatic generalized, 5% idiopathic generalized) were initiated on the ketogenic diet between 1/98-2/01. Mean duration that the diet was continued at the time of analysis is 7.6 months (0.7-24). Pts discontinued the diet due to lack of efficacy (16%), poor compliance (31%) and side effects (21%). 68% had a significant reduction in seizure frequency. 16% had no improvement. 5% had worsening of seizure frequency. Significant reductions in carnitine (21%) and selenium (26%) were the most commonly seen nutritional problems, but could be reversed with supplementation. Mean total cholesterol increase was 41 mg/dl. Mean chol/HDL ratio at last follow-up was 4.2 (baseline 3.95). No significant changes were noted in CBC, TSH, liver function tests, or 12-lead EKGs. Mild reductions in magnesium were noted in 2 patients. Significant improvement of the EEG was noted in 2 patients. Weight loss was seen in 58% of pts and median weight change was -4 kgs (range -28.6 to + 9.5). Reported side effects include constipation, fatigue, hypoglycemia, and menstrual irregularities.
CONCLUSIONS: The ketogenic diet is an effective therapeutic option in motivated adults with refractory epilepsy. Weight loss occurred (which was in some cases desired and planned in advance) in the majority of patients and may in part be related to side effects. In order to prevent observed nutritional derangements, supplementation with selenium and carnitine at initiation may be helpful. Lipids increase in the majority of patients but the long-term clinical significance is uncertain. Favorable cognitive and EEG changes may also occur.