Source:Pediatric Neurology
Author(s): Elaine Wirrell, Susan Eckert, Lily Wong-Kisiel, Eric Payne, Katherine Nickels
PurposeThe aim of this study was to evaluate tolerability and efficacy of the ketogenic diet in infants less than 12 months of age.MethodsInfants less than 12 months of age, commencing the ketogenic diet between 09/2007 and 07/2016 were identified. Records were reviewed for epilepsy details, diet initiation details, efficacy and tolerability.Results27 infants commenced the ketogenic diet (56% male, median age 7 months). Median age at seizure onset was 1.9 months and 92% had daily seizures. An epilepsy syndrome was noted in 19 (West-11, Epilepsy in Infancy with Migrating Focal Seizures-5, Early Myoclonic Encephalopathy-1, Ohtahara-1, Dravet-1). Infants were on a median of 2 and had failed a median of 1 antiepileptic drugs for lack of efficacy. All initiated a traditional ketogenic diet at full calories without fasting, and all but one started the diet in hospital.Significant hypoglycemia during initiation was seen in two - both had emesis +/- decreased oral intake. 88% developed urinary ketosis by 48 hours and all were successfully discharged on the diet (median ratio 3:1).Of those continuing the ketogenic diet, responder rates at 1, 6 and 12 months were 68%, 82% and 91%, with 20%, 29% and 27% achieving seizure freedom. By 12 months, 2 stopped the diet for serious adverse effects (1-markedly increased triglycerides, 1-dehydration and severe ketoacidosis), 5 discontinued for lack of efficacy, 6 were lost to follow-up and 2 died of unrelated causes.ConclusionsThe ketogenic diet is an effective and well-tolerated treatment for infants with intractable epilepsy. In-hospital initiation is strongly recommended due to risk of hypoglycemia with emesis or reduced intake.
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