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: Ketogenic diet has been frequently used in the treatment of intractable childhood epilepsy since proven strong antiepileptic effects. Because of prolonged maintenance of high fat diet, long-term side effects of hyperlipidemia and atherosclerosis has been concerned, but there are no sufficient data revealing lipid profile from ketogenic diet. This study is intended to investigate the changes of lipid profiles in patients with ketogenic diet. METHODS: Sixty-six children (0.8-14.7 yrs, mean age 4.6+/-3.6 yrs, 33 males and 33 females) with intractable epilepsy treated with the classic (4:1) ketogenic diet were studied at Inje University Sang-gye Paik Hospital, from January 1997 to July 2001. Follow-up period was more than 1year (range:1-2 yrs). Cholesterol, HDL-cholesterol and Triglyceride (TG) concentrations were measured at 1 day, 7 days, 6 months, 12 months, 18 months and 24 months, and LDL-cholesterol concentrations were measured. RESULTS: 1) Total cholesterol concentrations were significantly increased from 7 days to 24 months after ketogenic diet than that before ketogenic diet (p<0.05). 2) HDL-cholesterol concentrations were not significantly changed for 2 years. 3) LDL-cholesterol concentrations were significantly increased at 6 months (119.9 mg/dL, p<0.05), and 24 months (128.0 mg/dL, p<0.05). 4) TG concentrations were significantly increased at 7 days (164.9 mg/dL, p<0.05), 6 months (209.7 mg/dL, p<0.01), and 12 months (192.0 mg/dL, p<0.01), and were normalized at 18 months, 24 months. CONCLUSION: Most of lipid profiles were significantly changed during ketogenic diet. Long-term complication for cardio-vascular diseases should be further investigated.
Atherosclerosis ; Child ; Cholesterol ; Diet, High-Fat ; Epilepsy* ; Follow-Up Studies ; Humans ; Hyperlipidemias ; Ketogenic Diet* ; Male ; Triglycerides

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

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

BACKGROUND AND PURPOSE: Despite the successful use of a ketogenic diet in pediatric epilepsy, its application in adults has been limited. The aim of this meta-analysis was to summarize the findings of relevant published studies in order to identify the efficacy of and compliance with a ketogenic diet and its main subtypes (i.e., classic ketogenic diet and modified Atkins diet) in adults with intractable epilepsy, and to provide useful information for clinical practice. METHODS: Electronic searches of PubMed, EMBASE, Google Scholar, and the ISI Web of Science were conducted to identify studies of the efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy; the included studies were reviewed. Meta-analyses were performed using STATA to determine combined efficacy rates and combined rates of compliance with the ketogenic diet and its main subtypes. RESULTS: In total, 12 studies qualified for inclusion, and data from 270 patients were evaluated.The results of the meta-analysis revealed combined efficacy rates of all types of ketogenic diet, a classical ketogenic diet, and a modified Atkins diet were 42%, 52%, and 34%, respectively; the corresponding combined compliance rates were 45%, 38%, and 56%. CONCLUSIONS: The results indicate that a ketogenic diet is a promising complementary therapy in adult intractable epilepsy, and that while a classical ketogenic diet may be more effective, adult patients are likely to be less compliant with it than with a modified Atkins diet.
Adult* ; Compliance ; Diet, Carbohydrate-Restricted ; Epilepsy* ; Humans ; Ketogenic Diet* ; Patient Compliance*

PURPOSE: Ketogenic diet(KD) is an alternative treatment for children with intractable seizures. This study was performed to evaluate the efficacy and tolerability of ketogenic diet METHODS: A retrospective study was performed for 57 patients(31 males, and 25 females), who were enrolled in a ketogenic diet program from 1998 to 2003 in Seoul National University Children's Hospital. We investigated the overall efficacy, influencing factors such as age at diet onset, seizure type, initial fasting, adverse events and reasons for discontinuing the diet. RESULTS: The patients mean age at diet onset was 3.5 years old. They had 3.14 medications on average at the diet initiation. One month after the diet initiation, 49 of 57(86 %) remained on KD, with 37(64.9%) having more than 50% seizure reduction rates. At 6 months, half of the patients remained on KD, with 14(28%) seizure free and 22(44%) having more than 50% seizure reduction rates. At 12 months, 15 patients(34.9%) remained on KD, with 14(32.6%) having more than 90% seizure reduction rates. Seizure types, initial fasting and age at diet onset were not statistically related to the outcomes. There were a few complications during the diet. The most common reasons for discontinuing KD were ineffectiveness and poor tolerability. CONCLUSION: Ketogenic diet appears to be a relatively effective and safe treatment option for children with intractable epilepsies.
Child ; Diet ; Epilepsy* ; Fasting ; Humans ; Ketogenic Diet* ; Male ; Retrospective Studies ; Seizures ; Seoul

PURPOSE: Ketogenic diet(KD) is an alternative treatment for children with intractable seizures. This study was performed to evaluate the efficacy and tolerability of ketogenic diet METHODS: A retrospective study was performed for 57 patients(31 males, and 25 females), who were enrolled in a ketogenic diet program from 1998 to 2003 in Seoul National University Children's Hospital. We investigated the overall efficacy, influencing factors such as age at diet onset, seizure type, initial fasting, adverse events and reasons for discontinuing the diet. RESULTS: The patients mean age at diet onset was 3.5 years old. They had 3.14 medications on average at the diet initiation. One month after the diet initiation, 49 of 57(86 %) remained on KD, with 37(64.9%) having more than 50% seizure reduction rates. At 6 months, half of the patients remained on KD, with 14(28%) seizure free and 22(44%) having more than 50% seizure reduction rates. At 12 months, 15 patients(34.9%) remained on KD, with 14(32.6%) having more than 90% seizure reduction rates. Seizure types, initial fasting and age at diet onset were not statistically related to the outcomes. There were a few complications during the diet. The most common reasons for discontinuing KD were ineffectiveness and poor tolerability. CONCLUSION: Ketogenic diet appears to be a relatively effective and safe treatment option for children with intractable epilepsies.
Child ; Diet ; Epilepsy* ; Fasting ; Humans ; Ketogenic Diet* ; Male ; Retrospective Studies ; Seizures ; Seoul