The Ketogenic and Modified Atkins Diet Therapy for Children With Refractory Epilepsy of Genetic Etiology

Spoorthi Jagadish, Eric T. Payne, Lily Wong-Kisiel, Katherine C Nickels, Susan Eckert, Elaine C Wirrell

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Abstract

Background: The ketogenic diet is an accepted treatment modality in refractory childhood epilepsy. In this study, we analyzed the efficacy and tolerability of the ketogenic and modified Atkins diets in children with refractory epilepsy of genetic etiology and studied the effect of the diet on seizure frequency. Methods: The records of children with a genetic etiology for refractory epilepsy treated with ketogenic and modified Atkins diet between September 2005 and July 2016 were reviewed. We documented age of seizure and diet onset, seizure characteristics, and specific genetic etiology. The proportion of children remaining on the diet and responder rates (greater than 50% seizure reduction) were noted at one, three, six, 12, and 24 months after diet initiation. Tolerability and safety profile were also recorded. Results: Fifty-nine children with a genetic etiology (63% females, median age at diet onset 2.2 years) were initiated on the diet at our center. Fifty-three (90%) were started on a traditional ketogenic diet, whereas six started a modified Atkins diet. The adverse events at the initiation of diet were vomiting (24%), hypoglycemia (15%), and refusal to feed (11%). Three children stopped the diet before discharge because of poor compliance, severe reflux, and ketoacidosis (n = 1 each). The proportion of children remaining on the diet at one, three, six, 12, and 24 months was 95%, 86%, 69%, 64%, and 47%. The responder rates were 63%, 61%, 54%, 53%, and 41% at one, three, six, 12, and 24 months, respectively. Conclusions: The ketogenic diet is an effective treatment modality in children with refractory epilepsy of genetic etiology.

Original languageEnglish (US)
JournalPediatric Neurology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Carbohydrate-Restricted Diet
Diet Therapy
Epilepsy
Diet
Ketogenic Diet
Seizures
Ketosis
Age of Onset
Hypoglycemia
Vomiting
Safety

Keywords

  • Genetic epilepsy
  • Ketogenic diet
  • Modified Atkins diet
  • Refractory seizures

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Neurology
  • Developmental Neuroscience
  • Clinical Neurology

Cite this

The Ketogenic and Modified Atkins Diet Therapy for Children With Refractory Epilepsy of Genetic Etiology. / Jagadish, Spoorthi; Payne, Eric T.; Wong-Kisiel, Lily; Nickels, Katherine C; Eckert, Susan; Wirrell, Elaine C.

In: Pediatric Neurology, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: The ketogenic diet is an accepted treatment modality in refractory childhood epilepsy. In this study, we analyzed the efficacy and tolerability of the ketogenic and modified Atkins diets in children with refractory epilepsy of genetic etiology and studied the effect of the diet on seizure frequency. Methods: The records of children with a genetic etiology for refractory epilepsy treated with ketogenic and modified Atkins diet between September 2005 and July 2016 were reviewed. We documented age of seizure and diet onset, seizure characteristics, and specific genetic etiology. The proportion of children remaining on the diet and responder rates (greater than 50{\%} seizure reduction) were noted at one, three, six, 12, and 24 months after diet initiation. Tolerability and safety profile were also recorded. Results: Fifty-nine children with a genetic etiology (63{\%} females, median age at diet onset 2.2 years) were initiated on the diet at our center. Fifty-three (90{\%}) were started on a traditional ketogenic diet, whereas six started a modified Atkins diet. The adverse events at the initiation of diet were vomiting (24{\%}), hypoglycemia (15{\%}), and refusal to feed (11{\%}). Three children stopped the diet before discharge because of poor compliance, severe reflux, and ketoacidosis (n = 1 each). The proportion of children remaining on the diet at one, three, six, 12, and 24 months was 95{\%}, 86{\%}, 69{\%}, 64{\%}, and 47{\%}. The responder rates were 63{\%}, 61{\%}, 54{\%}, 53{\%}, and 41{\%} at one, three, six, 12, and 24 months, respectively. Conclusions: The ketogenic diet is an effective treatment modality in children with refractory epilepsy of genetic etiology.",
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AU - Eckert, Susan

AU - Wirrell, Elaine C

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N2 - Background: The ketogenic diet is an accepted treatment modality in refractory childhood epilepsy. In this study, we analyzed the efficacy and tolerability of the ketogenic and modified Atkins diets in children with refractory epilepsy of genetic etiology and studied the effect of the diet on seizure frequency. Methods: The records of children with a genetic etiology for refractory epilepsy treated with ketogenic and modified Atkins diet between September 2005 and July 2016 were reviewed. We documented age of seizure and diet onset, seizure characteristics, and specific genetic etiology. The proportion of children remaining on the diet and responder rates (greater than 50% seizure reduction) were noted at one, three, six, 12, and 24 months after diet initiation. Tolerability and safety profile were also recorded. Results: Fifty-nine children with a genetic etiology (63% females, median age at diet onset 2.2 years) were initiated on the diet at our center. Fifty-three (90%) were started on a traditional ketogenic diet, whereas six started a modified Atkins diet. The adverse events at the initiation of diet were vomiting (24%), hypoglycemia (15%), and refusal to feed (11%). Three children stopped the diet before discharge because of poor compliance, severe reflux, and ketoacidosis (n = 1 each). The proportion of children remaining on the diet at one, three, six, 12, and 24 months was 95%, 86%, 69%, 64%, and 47%. The responder rates were 63%, 61%, 54%, 53%, and 41% at one, three, six, 12, and 24 months, respectively. Conclusions: The ketogenic diet is an effective treatment modality in children with refractory epilepsy of genetic etiology.

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KW - Refractory seizures

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