Efficacy of the ketogenic diet in children and adolescents with refractory epilepsy in a tertiary hospital

Abstract

Objective: Description of clinical characteristics and response to KD in children and adolescents with RE. Methods: Serial descriptive–retrospective study of children and adolescents with RE treated with KD between 2000–2016 in a tertiary hospital. Results: There were 86 patients, 54.7% male, with a diagnosis of focal epilepsy in 77.9%, generalized in 18.6% and not classifiable in 3.5%, of diverse etiologies, in 29% no clear etiology. Age of onset of seizures: neonatal in 10/86, 6.15 (+/− 3.8) months in 40/86, 4.32 years (+/− 2.7) in 3/86 patients and in 5 we had no registry. Age of onset of KD: 2 to 6m (+/− 4.2) (mode); range 1m–17a. Time with KD: interquartile range 21.75 months (+/− 21.15). Efficacy of KD with reduction > 50% in the number of seizures in 54.8%, with complete remission of seizures in 12.8%; reduction <50% in 36%, worsening in 5% and in 4% there was no record. There was no statistically significant difference in the efficacy of KD according to the type of epilepsy or etiology. In 6/86 there was additional significant behavioral improvement and alertness. Complications in 24/86 (27%), the most frequent hypoglycemia, diarrhea, constipation and hypercholesterolemia; only in 4/24 motivated abandonment of DC. Total dropout rate 47%, mostly for non-eficacy. Conclusion: In our series of children and adolescents with RE, the KD is an effective and safe therapeutic alternative regardless of the type of epilepsy or etiology from the first months of life.