Abstracts

Rationale: Refractory epilepsy, by definition, leaves patients at an impasse between multi drug regimens and lack of seizure control. We looked at 13 pediatric patients with varying epileptic syndromes refractory to anti-epileptic drugs ( AEDs) to assess seizure reduction and side effects after initiation of a ketogenic diet or Modified Atkins Diet (MAD).Methods: We conducted a retrospective chart review of 13 pediatric patients that had been started on a KGD or MAD after failing to achieve seizure control on at least two AEDs. Data included past medication attempts, EEG and imaging records, diet start date, change in seizure quantity, diet side effects, and patient compliance to diet protocol. Data analysis was done on an individual patient basis given the variety of clinical seizure presentation and severity.Results: Patients that were compliant with the KGD showed significant seizure reduction within the first year. Approximately 90% or greater seizure reduction was noted in 38.5% (5 total) of patients, 75% seizure reduction was noted in 38.5% ( 5 total) of patients, and 50% seizure reduction was noted in 7.6% ( 1 total) of patients. Two patients were non compliant with their diet and were removed from the study. Neuroimaging showed that 46% had ventricular enlargement. 23% were diagnosed with Lennox-Gastaut syndrome. 15.3% patients had EEGs congruent with the diagnosis of Ohtahara syndrome.All of these patients showed a 75% reduction in seizure quantity. Complications of the diet included dehydration , failure to thrive, excess weight gain and nephrolithiasis.Conclusions: The Ketogenic diet is helpful for refractory epilepsy, even in cases of incurable diagnoses. There are potential confounders as diets are hard to follow through and medications are often adjusted. Despite these variables, to see such significant seizure reduction in cases that typically do not improve with age or respond to AEDs such as Lennox-Gastaut and Ohtahara syndrome strengthens the argument for the efficacy of the KGD as treatment in these patient populations. In addition, the KGD is safe in the pediatric population as most side effects can be corrected for with dietary changes.