The Efficacy of Ketogenic Diet in 60 Chinese Patients With Dravet Syndrome.

Xiaojuan Tian,Yuehua Zhang,Xiru Wu,Jing Zhang,Jiaoyang Chen,Xiaoling Yang,Fang Fang,Ye Wu,Yao Zhang,Taoyun Ji

doi:10.3389/fneur.2019.00625

Abstract

Objective: To evaluate the efficacy and safety of ketogenic diet (KD) in patients with Dravet syndrome (DS).Methods: 60 DS patients receiving treatment of KD for more than 12 weeks from 2009 to 2018 were analyzed retrospectively. Modified Johns Hopkins protocol was used to initiate KD. Seizure frequency, electroencephalogram (EEG), cognition, language, and motor function of the patients were assessed. Side effects were monitored and adjusted accordingly. SPSS 23.0 software was used for all statistical analysis.Results: In total, 60 DS patients (34 boys, 26 girls) received treatment of KD for more than 12 weeks, and among them 41 (68.3%) patients remained on the diet for more than 24 weeks, 22 (36.7%) patients for more than 48 weeks. Seizures in 35 patients (58.3%) were reduced by over 50% at 12 weeks, and the KD effect was observed within 2 weeks in most of them. At 24 weeks, 61.1% (25/41) of the patients had a >50% seizure reduction. At 48 weeks, 77.3% (17/22) had an over 50% reduction in their seizure frequency. With the treatment of KD in the 60 DS patients, 10 patients had ever been seizure free for 12 months to 24 months (The median duration was 20 months). In 10 KD-effective patients, the background rhythm of their EEG showed obvious improvement, and interictal epileptic discharges decreased significantly. Cognitive function of 22 patients was improved. Language progressed in 14 patients. Motor function was improved in 13 patients. The efficacy of KD in DS patients did not correlate with the seizure onset age, the starting age of KD treatment, the SCN1A mutation and the numbers of antiepileptic drugs combined with KD treatment. The main adverse reactions of KD in the treatment process were gastrointestinal symptoms and metabolic disorders.Conclusions: KD treatment in DS patients has many advantages, including working rapidly, being effective in more than half of the DS patients and tolerable adverse reactions. Pharmoco-resistant DS patients are suggested to receive KD treatment.

Highlights

Dravet syndrome (DS) is a genetic and pharmaco-resistant infantile epilepsy syndrome, characterized by prolonged, febrile and afebrile seizures
Fifty-seven patients had episodes of status epilepticus
The duration of the Ketogenic diet (KD) ranged from 12 weeks to 54 months, with a median duration of 44 weeks. 41 (68.3%) patients remained on the diet for more than 24 weeks, 22 (36.7%) patients for more than 48 weeks

Summary

Introduction

Dravet syndrome (DS) is a genetic and pharmaco-resistant infantile epilepsy syndrome, characterized by prolonged, febrile and afebrile seizures. Most patients had cognitive impairment, and comorbidities, including autism-like behavior and attention problems. Conventional antiepileptic drugs (AEDs) are not effective enough in most DS patients [1]. Ketogenic diet (KD), a high-fat, adequate-protein and low carbohydrate diet, was first introduced as a therapeutic method for epileptic seizures in 1921 [4]. KD has been widely used in many different countries including China. Recent studies have demonstrated that KD therapy is a valuable feasible alternative to children with intractable epilepsy including DS [5,6,7,8,9]. We had a retrospective clinical observation of the effect and safety of KD in DS patients in a Chinese cohort

Methods

Results

Discussion

Conclusion