No abstract available.
Ketogenic Diet*

Objective: To evaluate the long-term efficacy, retention rate and tolerability of ketogenic diet treatment (KD) for children with medically refractory epilepsies from a single tertiary centre in Malaysia. Methods: Children who were treated with ketogenic diet since 2006 and had at least 2 years follow up after initiation of the KD were evaluated retrospectively using intention-to-treat principle. Response is defined at seizure reduction of > 50%. Efficacy was assessed as percentage of patients who had seizure reduction by >50%, >90% and seizure freedom and retention rate was the proportion of patients who remained on ketogenic diet. Result: A total of thirty children were included. The median duration of treatment was 8 months (range: 7 days to 6 years). Retention rates at 3, 6, 12 and 24 months were 80%, 70%, 50% and 40% and responder rates were 70%, 63%, 47% and 37% respectively. The common adverse effects were constipation (43%), hunger (23%), excessive weight gain or loss (20%), vomiting (10%), hyperuricaemia(30%), hypocalcaemia (20%) and renal calculi (13%). The common reasons for stopping were because the diet was too restrictive (33%), infrequent seizure or seizure freedom (23%), not effective (17%) but none was due to the adverse effects. Conclusion: Ketogenic diet treatment is effective and well-tolerated by Malaysian children in general.
Ketogenic Diet ; Epilepsy

No abstract available.
Animals* ; Ketogenic Diet* ; Models, Animal*

The ketogenic diet (KD) is an established, effective, nonpharmacologic treatment for children with pharmacoresistant epilepsy. Although the KD is the most well-established dietary therapy for epilepsy, it is too restrictive and is associated with serious complications; therefore, alternative lower-fat diets, including a modified Atkins diet and low-glycemic index diet, have been developed. Recent ongoing clinical evidence suggests that other dietary therapies have an efficacy almost comparable to that of the KD. In addition, a diet rich in polyunsaturated fatty acids appears to increase the efficacy of diet therapy and reduce the complications of a high-fat diet. Here, we review the systematic information about lower-fat diets and better-quality dietary therapies and the current clinical status of each of these dietary approaches.
Child ; Diet ; Diet, Carbohydrate-Restricted ; Diet, High-Fat ; Epilepsy ; Fatty Acids, Unsaturated ; Humans ; Ketogenic Diet

PURPOSE: The Ketogenic diet has been used since the 1920s as an alternative therapy to antiepileptic drugs in children with intractable epilepsy. This study was performed to provide information of clinical efficacy, adverse effects, tolerability and reasons for discontinuation. METHODS: This is a retrospective study concerning the change in frequency of seizures according to seizure classification, complication, tolerability and reasons for discontinuation in 25 children with intractable epilepsy who were treated with the 4:1 ketogenic diet. RESULTS: One month after diet initiation, complete cessation of seizures was observed in 5 children(20%), a greater than 50% reduction of seizures in 5 children(20%). One month after diet initiation, 72% continued the ketogenic diet. At 3 months, 44% continued the ketogenic diet. Most of those discontinued the diet because it was either ineffective or too unpalatable. Gastrointestinal side effects were observed in 10 children(40%), 8 controlled by supportive care, and 2 no longer maintaing the ketogenic diet. CONCLUSION: The ketogenic diet should be considered as an alternative therapy for children with intractable epilepsy. To maintain the ketogenic diet for a long time, family education, careful follow-up and development of various diet regimens should be considered.
Anticonvulsants ; Child ; Classification ; Diet ; Education ; Epilepsy* ; Follow-Up Studies ; Humans ; Ketogenic Diet* ; Retrospective Studies ; Seizures

PURPOSE: This study sought to evaluate the clinical outcomes of various therapeutic modalities, including newly-developed anti-epileptic drugs (AEDs), prednisolone, ketogenic diet (KD) epilepsy surgery, and vagus nerve stimulation (VNS), in treating intractable childhood epilepsy. METHODS: Data of refractory epilepsy patients (n=297) treated from July 1995 through April 2003 at the epilepsy center of Sanggye Paik Hospital were retrospectively analyzed. RESULTS: Newly-developed AEDs were primarily prescribed to 290 patients, although only 20 patients (6.9%) maintained a seizure- free state. Of 138 patients for whom prednisolone was prescribed, 58 patients (42.0%) showed complete seizure controls while 41 patients experienced relapse. KD was attempted and evaluated at 12 months in 162 patients, at which time 74 (45.7%) remained on the diet and 68 (42.0%) showed seizure reduction of greater than 50%, including 37 (22.8%) who were completely seizure free. Epilepsy surgery was undergone in 38 patients, and Engel class I was identified in 25 (65.8%) patients. VNS was administered to five patients, only two of whom obtained a seizure reduction of more than 50%. RESULTS: Taken together, these findings suggest that considerable controls over intractable childhood epilepsy can be gained through KD and epilepsy surgery, whereas prednisolone treatment leads to somewhat more frequent relapses, and newly-developed AEDs are comparatively limited in their controls of refractory epilepsy.
Diet ; Epilepsy* ; Humans ; Ketogenic Diet ; Prednisolone ; Recurrence ; Retrospective Studies ; Seizures ; Vagus Nerve Stimulation

PURPOSE: Malformation of cortical development(MCD) constitutes an important etiology of intractable epilepsy and is considered an indication for surgical treatments, though their efficacy is limited and variable depending on MCD's location or distribution. Ketogenic diets are widely known to be effective, but as little study has been made concerning their efficacy on epilepsy with MCD, we evaluated the efficacy of ketogenic diets on MCD patients compared with that of epileptic surgery, which is more invasive. METHODS: We performed retrospective studies and analyse on 30 patients with MCD diagnosed by brain MRI and treated with ketogenic diets for intractable epilepsy since 1998, checking decreases in their seizure episodes after starting the diets. RESULTS: Cortical dysplasia was observed in 24(80.0 percent) patients as the most common type of MCD. Also, MCD was observed in unilateral hemisphere most commonly, in 23(76.7 percent) patients; it was observed in both hemispheres in 7(23.3 percent) patients. Nine(30.0 percent) out of 30 patients became seizure-free after starting ketogenic diets, and 14(46.7 percent) patients experienced 50 percent seizure reductions as well. Age of starting the diet or the duration of epilepsy period before starting showed no statistical relationship with the efficacy of the diet. Though the younger the patient and the longer the treatment the more effective the diet seemed to be, there was no statistical correlation between them. The location of MCD showed no significance neither. CONCLUSION: Considering various limits and invasiveness of surgical treatment, a ketogenic diet could be a good tool in treating children with intractable epilepsy with MCD.
Brain ; Child ; Diet ; Epilepsy* ; Humans ; Ketogenic Diet* ; Magnetic Resonance Imaging ; Malformations of Cortical Development ; Retrospective Studies ; Seizures

Ketogenic diet is a high-fat, low-carbohydrate, low-protein diet used in the treatment of epilepsy since 1920's. Recently, it's use for intractable epilepsy in childhood has increased. Complications of ketogenic diet are known to include dehydration, vomiting, diarrhea, renal stones, metabolic derangement, hypercholesterolemia and refusal to eat. We experienced two cases of renal stones in children with intractable epilepsy during ketogenic diet.
Child ; Dehydration ; Diarrhea ; Diet, Protein-Restricted ; Disulfiram ; Epilepsy ; Humans ; Hypercholesterolemia ; Ketogenic Diet* ; Vomiting

In this paper, we report on a 5-year-old girl who developed a renal stone while following the ketogenic diet to treat refractory seizure disorder. Three months after initiating the ketogenic diet, she developed severe abdominal pain and vomiting. The spot urine calcium-to-creatinine (Ca/Cr) ratio and 24-hour urine evaluation showed hypercalciuria. Computed tomography (CT) imaging revealed a stone in the right ureteropelvic junction, resulting in hydronephrosis of the right kidney. The renal stone disappeared 5 days after conservative treatment; the patien's microscopic hematuria resolved concurrently. In light of this case report, we recommend regularly monitoring the urine Ca/Cr ratio with ultrasonography for further development of renal stones in patients following the ketogenic diet. If these patients exhibit evidence of symptomatic hypercalciuria or cyristalluria, liberalization of fluid restriction and urine alkalization using oral potassium citrate should be considered.
Child, Preschool ; Epilepsy/*diet therapy ; Female ; Humans ; Ketogenic Diet/*adverse effects/methods ; Kidney Calculi/*etiology

A ketogenic diet (KD) is a dietary approach to treat intractable epilepsy. The KD begins with hospitalization and the child and their parents can adapt to the KD for 1-2 weeks. Recently, various type of dietary intervention such as the modified Atkins diet (MAD) and the low glycemic index treatment (LGIT) have been performed. Since 2010, we carried out the KD, MAD, and LGIT for total of 802 patients; 489 patients (61%) for the KD, 147 patients (18.3%) with the MAD, and 166 patients (20.7%) for the LGIT. In this report, application of these dietary practices in Severance Hospital is shared.
Child* ; Diet, Carbohydrate-Restricted ; Epilepsy* ; Glycemic Index ; Hospitalization ; Humans ; Ketogenic Diet* ; Meals* ; Parents