Place of the Ketogenic Diet in Refractory Infantile Spasms

Abstract

Introduction: The ketogenic diet is an alternative nutritional regimen for refractory epilepsies, including infantile spasms. The objective of our study is the primary and secondary evaluation at 12 months of the effectiveness and tolerance of the ketogenic diet on seizure frequency, EEG (electroencephalogram) patterns, and side effects. Patients and Methods: We evaluated the ketogenic diet as a second- or third-line treatment, following corticosteroid therapy and/or Vigabatrin. We assessed the effectiveness and tolerance of the ketogenic diet based on patients being seizure-free, experiencing a reduction in seizures of more than 50%, improvement in EEG background pattern (suppression of hypsarrhythmia), psychomotor development, side effects, and reduction in antiepileptic drugs during clinical, electrical, and neurocognitive follow-ups at 1, 3, and 12 months. Results: Thirty-eight children, twentytwo boys, and sixteen girls, with a gender ratio of 1.37, presenting with infantile spasms visualized directly clinically or through videos and electric evaluation, with or without hypsarrhythmia on EEG, all symptomatic: genetic etiologies (14, 36.9%), structural in 18 patients (47.3%), and metabolic in six patients (15.8%). At 3 months, the number of patients who were seizure-free with a normal EEG was 22 patients (57.9%), and those with a reduction in seizures of more than 50%, 15 patients (39.5%). At 12 months on the ketogenic diet, the number of patients who were seizure-free was 24 (63.2%), and those with a reduction in seizures of more than 50% 14 patients(36.8%). Good tolerance and efficiency of the diet were confirmed by treatment compliance, maintained high response rate, and a reduction in the number of antiepileptic drugs to 1.97. The children became more vigilant, attentive, and responsive to their parents. Conclusion: Implementing the ketogenic diet within a short period of time, less than a year, would yield even better results in terms of seizure frequency and behavior in a developing infant brain.