Introduction

Out of the over 50 million people affected by epilepsy worldwide, over 80% live in low to middle income countries. Globally, refractory epilepsy affects one third of people living with epilepsy. With the limited treatment options available for refractory epilepsy in resource limited regions, the ketogenic diet is an important option to consider.

Methods

Adopting the 2015 International League Against Epilepsy recommended minimum requirements for ketogenic diet implementation, and through a partnership between  tertiary care centres in Zambia and the United States, three male children, aged 2.5, 6.5 and 10 years, with refractory epilepsy, on three or more drugs, were initiated on the diet using locally available food,in Zambia. The three patients represented a spectrum of the socioeconomic status of our population.

Results

Following a successful initiation, the diet was ultimately discontinued in the 10 year old due to difficulties complying with the diet. The youngest child with trisomy 21 and epileptic encephalopathy (epileptic spasms, atonic and myoclonic seizures) demonstrated an over 50% seizure reduction and gained developmental milestones. The third child achieved seizure freedom and showed marked improvement in behaviour.

Discussion

This pilot trial demonstrates the feasibility of ketogenic diet as an important therapeutic option for drug resistant epilepsy in the Zambian population. Acknowledging the limited treatment choices available in this setting, the diet, albeit more costly than the local carbohydrate rich diet, offers an alternative management strategy. Collaboration between an established ketogenic diet centre and site of implementation contributes to a successful program.