Introduction

Ketogenic Diet(KD), well-accepted therapy for drug-resistant epilepsy(DRE), can be tried on outpatient basis thereby reducing need of hospitalisation/starvation. Here, we analyse efficacy and safety profile of outpatient based ketogenic diet in children with DRE.

Methods

Children aged 0-18 years enrolled between 2008-2018, under “Keto Kid Project”-an outpatient based project  were included in this study. Demographic and clinical details, investigation profile in terms of epilepsy and suitability for diet were noted. Seizure control, other benefits in terms of behaviour and side effect profile were reviewed.

Results

117/138 children enrolled in programme who had completed three months on diet were taken for analysis. Median age at initiation of diet was 42 months(range:3.5-408 months); 38/117 were females. Two adolescents were initiated on Modified Atkins diet. 47/117 had vegetarian meal preferences. Lennox-Gastaut syndrome was the most common syndromic diagnosis(47/117) followed by West syndrome(32/117). 101/117 were initiated at 2:1; 89/101 were then maintained at <3:1. Mean duration on diet was 24.43 months. 69/117 had >50% seizure control while 26/69 had complete seizure freedom. Antiepileptic drugs(AED) reduced significantly after diet(p 0.0016).  Retention of diet was higher in children with better seizure control(p 0.0006). Other beneficial effects included alertness and improved behaviour. Main reasons for withdrawal were frequent infections, lack of benefit and poor compliance. None withdrew due to serious adverse events.

Conclusions

• 76% of the patients were managed at ratios <3:1 making the diet more palatable, with improved quantities and sustainable.
• KD in vegetarians is easy to manage
• Reduction in AEDs after KD were significant