Last modified: 2014-04-03
Abstract
Objective: To determine the efficacy of the ketogenic diet (KD) in controlling Epileptic spasms (ES) after failing traditional therapy.
Methods: All Infants with epileptic spasms who were referred for KD treatment at our hospital between 2009 and 2012. All subjects had ES with evidence of hypsarrythmia or severe epileptic encephalopathy on electroencephalogram (EEG) despite appropriate medication treatments. The diet efficacy was assessed through clinic visits, phone communications and/or EEGs every 3 months. Quality of life improvement was charted based on the care giver’s perspective.
Results: 20 infants (15 males) were included in the study. The mean age at seizure onset was 4.5 months. Age at KD initiation mean 1.20, SD 0.78. 15 patients had cryptogenic ES. 15 failed to respond to ACTH and/or vigabatrin before going on the KD. The remaining 5 patients tried at least 3 other antiepileptic medications before the diet was started. Three months after starting the diet >50% seizure reduction was achieved in 70%. These results were maintained at 6 and 12 months intervals. At 24 months follow up all patients had >50% seizure reduction. At least 90% seizure reduction was reported in 20% of patients at 3 months, 22% at 6 months and 35% at 12 months. Majority of patients (63%) achieved improvement of their spasms within one month after starting the diet. All care givers reported improvement of the quality of life at 3 months visit. This ratio was 94% at 6 months and 82% at 12 months.
Conclusion: KD is safe and potentially effective treatment for patients with ES; especially those who failed medication therapies.
Keywords
References
[1]. Riikonen R. Epidemiological data of West syndrome in Finland. Brain Dev 2001;23:539 –541.
[1]. Ludvigsson P, O´ lafsson E, Sigurardóttir S, Hauser WA. Epidemiologic features of epileptic spasms in Iceland. Epilepsia 1994;35:802– 805.
[1]. Trevathan E, Murphy CC, Yeargin-Allsopp M. The descriptive epidemiology of epileptic spasms among Atlanta children. Epilepsia 1999;40:748 –751.
[1]. Riikonen R. Long-term outcome of patients with West syndrome. Brain Dev 2001;23:683–687.
[1]. C.Y. Go, M.T. Mackay, S.K. Weiss, et al. Evidence-based guideline update: Medical treatment of epileptic spasms : Report of the Guideline Development Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2012;78:1974-1980.
[1]. Tsao CY. Current trends in the treatment of epileptic spasms. Neuropsychiatr Dis Treat 2009;5:289–299.
[1]. Hosain SA, Merchant S, Solomon GE, Chutorian A. Topiramate for the treatment of epileptic spasms. J Child Neurol 2006;21:17–19.
[1]. Korinthenberg R, Schreiner A. Topiramate in children with west syndrome: a retrospective multicenter evaluation of 100 patients. J Child Neurol 2007;22:302–306
[1]. Nordli DR, Kuroda MM, Carroll J, Koenigsberger DY, Hirsch LJ, Bruner HJ, Seidel WT, De Vivo DC. Experience with the ketogenic diet in infants. Pediatrics 2001;108:129–133.
[1]. Eun SH, Kang HC, Kim DW, Kim HD. Ketogenic diet for treatment of epileptic spasms. Brain Dev 2006;28:566–571.
[1]. Hong AM, Turner Z, Hamdy RF and Kossoff EH. Epileptic spasms treated with the ketogenic diet: Prospective single-center experience in 104 consecutive infants. Epilepsia 2010;51(8):1403–1407.
[1]. Kossoff EH, Hedderick EF, Turner Z, Freeman JM. A case–control evaluation of the ketogenic diet versus ACTH for new-onset epileptic spasms. Epilepsia 2008; 49:1504–1509.
[1]. Hrachovy RA, Glaze DG, Frost JD Jr. (1991) A retrospective study of spontaneous remission and long-term outcome in patients with epileptic spasms. Epilepsia 32:212–214.