Abstract
With the rising demand for ketogenic diet therapy in adult epilepsy, there is a need for research describing the real-life effectiveness, retention, and safety of relevant services. In this 1-year prospective cohort study we present outcomes of the first 100 referrals for modified ketogenic diet (MKD) at the UK’s largest tertiary-care epilepsy centre, where patients received dietetic review up to twice per week. Of the first 100 referrals, 42 (31 females, 11 males; mean age 36.8 [SD ± 11.4 years]) commenced MKD, having used a mean of 4 (SD ± 3) previous antiepileptic drugs. Retention rates were: 60% at 3 months, 43% at 6 months, and 29% at 12 months. 60% of patients reported an improvement in seizure frequency, 38% reported a > 50% reduction, and 13% reported a period of seizure freedom; 30% reported a worsening in seizure frequency at some point during MKD therapy. The most common reasons for discontinuing MKD were side effects and diet restrictiveness. The most common side effects were weight loss, gastrointestinal symptoms and low mood. The likelihood of discontinuing MKD was significantly decreased by experiencing an improvement in seizure frequency (p ≤ 0.001). This study demonstrates that MKD can be effective in adults, although, even with regular dietetic support, retention rates remain low, and periods of worsening seizure frequency are common.
Highlights
One third of adult epilepsy patients do not achieve seizure freedom with antiepileptic drugs (AEDs) [1, 2]. Those who have failed on two AEDs have been found to have a < 5% chance of achieving seizure freedom with a further AED trial [3]
We present outcomes of the first 100 referrals to a dedicated ketogenic diet service for adults with drug-resistant epilepsy at the largest epilepsy centre in the UK
This was a prospective cohort study of the first 100 referrals made to the Adult Ketogenic Diet Service at the National Hospital for Neurology and Neurosurgery, Queen Square, London, with patients commencing modified ketogenic diet (MKD) between January 2016 and January 2018
Summary
One third of adult epilepsy patients do not achieve seizure freedom with antiepileptic drugs (AEDs) [1, 2]. Whilst the ‘classic’ ketogenic diet involves a strict 3:1–4:1 ratio of fats to combined carbohydrate and protein, a number of variations have been developed in an attempt to improve tolerability and reduce adverse effects. These include the modified Atkins diet (MAD), low glycaemic index treatment, and the modified ketogenic diet (MKD). The mechanism behind the putative antiepileptic effects of dietary manipulation remains unclear (for a review, see [9])
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