Abstracts

Rationale: Ketogenic diet (KD)is a method of treatment basically defined as a high-fat, low protein and low carbohydrate diet used since the 1920s in childhood refractor epilepsy. In addition to its known side effects, it is considered to lead to an increase in infection frequency causing possible neutrophile function impairment and the reason behind this has not yet been explained completely. Setting off from this point, in this study we aimed at comparing the immunoglobulin levels, frequency and severity of infection in patients given ketogenic diet before and after the therapy. Methods: The hospital records of the patients given KD due to resistant epilepsy in the pediatric neurology department of our hospital between January 2012 andMarch 2013 were examined retrospectively. Age, sex, diagnosis, period of KD therapy, KD rate applied, levels of Ig G, Ig A, Ig M (mg/dl) at least a week before KD, 3 months after the beginning of KD and monthly frequency of infection before and after KD and the types of these infections were recorded. Moreover, in order to determine the efficacy of the treatment, the number of monthly frequency of infection before and after KD and the antiepileptic drugs (AED) given were determined. Upper respiratory tract infection (URTI), lower urinary tract infection (UTI), acute gastroenteritis (AGE) not requiring hospitalization, minor infection, lower respiratory tract infection (LRTI), upper UTI, sepsis and meningitis were recorded as severe infections. Results: Among the 49 patients receiving KD, 36 were meeting the criteria of acceptance into the study. 17 (47%) of the patients were females and 19 (53%) males; and the mean age was found as 39,5 (IQR 51,5) months. In the cases all of whom were observed due to resistant epilepsy, 3 most frequent diagnoses were tuberous sclerosis (n=9, 25%), idiopathic resistant epilepsy (n=8, 22,2%) and West syndrome (n=6, 16,7%). Mean KD application period was found as 3 months (IQR: 2, min 3 max 10). The rate of KD applied to patients was recorded as follows; 15 patient (41,5%) 3/1, 14 patients (39%) 4/1, 5 patients (14%) 2,5/1 and 2 patients(5,5%) 4,5/1. All Ig G, A, M levels were on normal levels in terms of the age after and before KD. No significant difference was found in terms of the number and severity of infections before and after the implementation of KD (p=0,057, p=1). The numbers of monthly seizures and AED after KD were determined to have fallen significantly in comparison to those before KD (p< 0,001, p< 0,001). Furthermore, it was observed that in 5 patients the epileptic encephalopathy manifestation existence before KD was completely removed after the treatment.Conclusions: In this study, none of our patients showed a decrease in lg levels below normal for their ages after Ketogenic diet treatment. In our study, no increase in the frequency and or improvement in the severity of infection was found in any of the patients after Ketogenic diet. In addition this treatment was found to be rather effective.