Abstracts

Approximately 10% of children on the ketogenic diet become seizure-free after its initiation. The diet typically is discontinued after 2 years, but there is no information regarding the likelihood and severity of seizure recurrence., A retrospective chart review examined children who became seizure-free on the ketogenic diet at our institution over a 12-year period; the indication for discontinuing the diet was freedom from seizures. All children had at least 6 months of seizure freedom and were on the diet for that period prior to discontinuation., Sixty-six children discontinued the diet after a median of 2.1 years due to seizure freedom; 92% were medication-free. Twelve (18%) had recurrence of their seizures at a median of 3.0 years after the diet was stopped. Seven (58%) became seizure-free a second time, 2 after reinstitution of the diet. Four patients restarted the diet but remain intractable to date. The presence of recent electrographic epileptiform activity and an abnormal MRI each significantly increased the likelihood of recurrence (45% and 38%, respectively); age, seizure type, seizure frequency, medication freedom, and time to initial diet response did not. Three patients with recurrent seizures had tuberous sclerosis complex., The risk of recurrent seizures subsequent to discontinuing the diet after achieving seizure freedom was approximately 1 in 5, and more than half became seizure-free again, usually with anticonvulsants alone. The risk of recurrent intractability was three times less; however the diet, when restarted in these patients, was not as successful. Obtaining a recent EEG prior to discontinuing the diet in this situation may be advisable in counseling families.,