Efficacy and safety of the ketogenic diet therapy in Pakistani children with refractory epilepsy

Main Article Content

Naveed Anjum
Faisal Zafar
Muhammad Yousuf
Zia-ur-Rehman Khattak

Abstract

OBJECTIVE: To find the effectiveness and tolerability of the ketogenic diet (KD) for Pakistani children with refractory epilepsy. 


METHODS: This study was conducted at Child Neurology Department, Children's Hospital & Institute of Child Health Multan, Pakistan. Data of diagnosed patients of refractory epilepsy, not responding to ≥2 antiepileptic drugs (AEDs), were well-tolerated, adequately utilized and received KD treatment from 2017 to 2020 was retrieved and analyzed. Data was analyzed through SPSS-23.


RESULTS: Fifty-five children, including 18 (32.7%) girls and 37 (67.3%) boys, underwent KD initiation phase. Forty (72.7%) children received >2 AEDs. Fifteen (27.3%) children had >17 months’ duration of epilepsy. Type of epilepsy was undetermined in 25 (45.5%) cases, 14 (25.5%) had epileptic syndrome & 8 (14.5%) had progressive myoclonic epilepsy. Spasm (n=19, (34.5%), tonic (n=14; 25.5%) and tonic-clonic (n=7; 12.7%) were the commonest types of seizures. Out of 55 patients, 51 (92.7%), 39 (70.9%) & 24 (43.6%) patients continued CD for three, six and twelve months respectively.  Seizure-free status at three, six and twelve months was achieved in 29.4% (n=15/51), 28.2% (n=11/39) and 25% (n=6/24) cases respectively. While >75% reduction in seizures at three, six and twelve months was observed in 31.4% (n=16 /51), 33.4% (n=13/39) and 29.1% (n=7/24) cases respectively. Common side effects included anorexia (n=30/55; 54.55%), diarrhea (n=12; 21.82%), kidney stones (n=7; 12.73%), and other side effects like constipation, hypoglycemia, ketoacidosis and gravel (n=6, 10.91%).


CONCLUSION: KD combined with gradual commencement approaches is safe and effective therapy for Pakistani children with refractory epilepsy.

Article Details

How to Cite
Anjum, Naveed, et al. “Efficacy and Safety of the Ketogenic Diet Therapy in Pakistani Children With Refractory Epilepsy”. KHYBER MEDICAL UNIVERSITY JOURNAL, vol. 15, no. 2, June 2023, pp. 111-5, doi:10.35845/kmuj.2023.23082.
Section
Original Articles

References

Ge Y, Yu P, Ding D Wang P, Shi Y, Zhao T, et al. Etiologic features and utilization of antiepileptic drugs in people with chronic epilepsy in China: Report from the Epilepsy Cohort of Huashan Hospital (ECoH). Epilepsy Res 2015:99-104. https://doi.org/10.1016/j.eplepsyres.2015.07.006

Jehi L, Jette N, Kwon CS, Josephson CB, Burneo JG, Cendes F, et al. Timing of referral to evaluate for epilepsy surgery: Expert Consensus Recommendations from the Surgical Therapies Commission of the International League Against Epilepsy. Epilepsia 2022;63(10):2491-506. https://doi.org/10.1111/epi.17350

Sillanpää M, Schmidt D. Natural history of treated childhood-onset epilepsy: a prospective, long-term population-based study. Brain 2006;129(Pt 3):617-24. https://doi.org/10.1093/brain/awh726

Guazzi M, Striano P. GABA strikes down again in epilepsy. Ann Transl Med 2019;7(3): 57. https://doi.org/10.21037/atm.2018.12.55

Loring DW, Marino S, Meador KJ. Neuropsychological and behavioral effects of antiepilepsy drugs. Neuropsychol Rev 2007;17(4):413-25. https://doi.org/10.1007/s11065-007-9043-9

Roehl K, Falco-Walter J, Ouyang B, Balabanov A. Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, severity, and quality of life. Epilepsy Behav 2019;93:113-8. https://doi.org/10.1016/j.yebeh.2018.12.010

van Berkel AA, DM IJ, Verkuyl JM. Cognitive benefits of the ketogenic diet in patients with epilepsy: A systematic overview. Epilepsy Behav 2018;87:69-77. https://doi.org/10.1016/j.yebeh.2018.06.004

Winesett SP, Bessone SK, Kossoff EH. The ketogenic diet in pharmacoresistant childhood epilepsy. Expert Rev Neurother 2015;15(6):621-8. https://doi.org/10.1586/14737175.2015.1044982

Sariego-Jamardo A, Garcia-Cazorla A, Artuch R, Castejón E, García-Arenas D, Molero-Luis M, et al. Efficacy of the ketogenic diet for the treatment of refractory childhood epilepsy: cerebrospinal fluid neurotransmitters and amino acid levels. Pediatr Neurol 2015;53(5):422-6. https://doi.org/10.1016/j.pediatrneurol.2015.07.013

Luz IR, Pereira C, Garcia P, Ferreira F, Faria A, Macedo C, et al. Ketogenic diet for refractory childhood epilepsy: beyond seizures control, the experience of a Portuguese pediatric centre. Acta Med Port 2019:760-66. https://doi.org/10.20344/amp.12184

De Amicis R, Leone A, Lessa C, Foppiani A, Ravella S, Ravasenghi S, et al. Long-term effects of a classic ketogenic diet on ghrelin and leptin concentration: A 12-month prospective study in a cohort of Italian children and adults with GLUT1-deficiency syndrome and drug-resistant epilepsy. Nutrients 2019;11(8):1716. https://doi.org/10.3390/nu11081716

Epilepsy Association Pakistan, 2020. Accessed on: June 15, 2022. Available from URL: https://nationalepilepsycentre.org.pk/

Baby N, Vinayan KP, Pavithran N, Grace RA. A pragmatic study on efficacy, tolerability and long-term acceptance of ketogenic diet therapy in 74 south Indian children with pharmacoresistant epilepsy. Seizure 2018;58:41-6. https://doi.org/10.1016/j.seizure.2018.03.020

Lambrechts DAJE, de Kinderen RJA, Vles JSH, de Louw AJA, Aldenkanp AP, Majoie HJM. A randomized controlled trial of the ketogenic diet in refractory childhood epilepsy. Acta Neurol Scand 2017;135(2):231-9. https://doi.org/10.1111/ane.12592

Lefevre F, Aronson N. Ketogenic diet for treating refractory epilepsy in children: a systematic review of efficacy. Pediatrics 2000;105(4):E46. https://doi.org/10.1542/peds.105.4.e46

Neal EG, Chafe H, Schwartz RH, Lawson MS, Edwards N, Fitzsimmons G, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomized controlled trial. Lancet Neurol 2008;7(6):500-6. https://doi.org/10.1016/S1474-4422(08)70092-9

Qin S, Qin Q, Zhou S, Ketogenic Diet Study Group of the Subspecialty Group of Neurology, the Society of Pediatrics, Chinese Medical Association. Prospective multicenter study on long-term ketogenic diet therapy for intractable childhood epilepsy. Zhonghua Er Ke Za Zhi 2013;51(4):276-82. https://doi.org/10.3760cma.j.issn.0578.1310.2013.04.008

Guzel O, Uysal U, Arslan N. Efficacy and tolerability of olive oil-based ketogenic diet in children with drug-resistant epilepsy: a single center experience from Turkey. Eur J Paediatr Neurol 2019;23:143-51. https://doi.org/10.1016/j.ejpn.2018.11.007

Hallböök T, Sjölander A, Åmark P, Miranda M, Bjurulf B, Dahlin M, et al. Effectiveness’ of the ketogenic diet used to treat resistant childhood epilepsy in Scandinavia. Eur J Paediatr Neurol 2015;19(1):29-36. https://doi.org/10.1016/j.ejpn.2014.09.005

Kossof EH, Zupec-Kania BA, Auvin S, Ballaban-Gil KR, Bergqvist C, Blackford R, et al. Optimal clinical management of children receiving dietary therapies for epilepsy: updated recommendations of the international Ketogenic diet study group. Epilepsia Open 2018:175-92. https://doi.org/10.1002/epi4.12225

Henderson CB, Filloux FM, Alder SC, Lyon JL, Caplin DA. Efcacy of the ketogenic diet as a treatment option for epilepsy: a meta-analysis. J Child Neurol 2006;21(3):193-8. https://doi.org/10.2310/7010.2006.00044

Kossof EH, McGrogan JR, Bluml RM, Pillas DJ, Robenstein JE, Vinning EP. A modified Atkins diet is effective for the treatment of intractable pediatric epilepsy. Epilepsia 2006;47(2):421-4. https://doi.org/10.1111/j.1528-1167.2006.00438.x

Katyal NG, Koehler AN, McGhee B, Foley CM, Crumrine PK. The ketogenic diet in refractory epilepsy: the experience of Children’s Hospital of Pittsburgh. Clin Pediatr (Phila) 2000;39(3):153-9. https://doi.org/10.1177/000992280003900303

Caraballo R, Vaccarezza M, Cersósimo R, Rios V, Soraru A, Arroyo H, et al. Long-term follow-up of the ketogenic diet for refractory epilepsy: multicenter Argentinean experience in 216 pediatric patients. Seizure 2011;20(8):P640-45. https://doi.org/10.1016/j.seizure.2011.06.009

Lin A, Turner Z, Doerrer SC, Stanfield A, Kossoff EH. Complications during Ketogenic diet initiation: prevalence, treatment, and influence on seizure outcomes. Pediatr Neurol 2017;68:35-9. https://doi.org/10.1016/j.pediatrneurol.2017.01.007

Nordli DR, Kuroda MM, Carroll J, Koenigsberger DY, Hirsch LJ, Bruner HJ, et al. Experience with the ketogenic diet in infants. Pediatrics 2001;108(1):129-33. https://doi.org/10.1542/peds.108.1.129

Zamani GR, Mohammadi M, Ashraf MR, Karimi P, Mahmoudi M, Badv RS, et al. The effects of a classic ketogenic diet on serum lipid profile in children with refractory seizures. Acta Neurol Belg. 2016;116: 529-34. https://doi.org/10.1007/s13760-016-0601-x

Duo X, Xu X, Mo T, Chen H, Wang Z, Li X, et al. Evaluation of the seizure control and the tolerability of ketogenic diet in Chinese children with structural drug-resistant epilepsy. Seizure 2021;94:43-51. https://doi.org/10.1016/j.seizure.2021.11.008

Mubarak R, Raza I, Khursheed A, Mushtaq M, Hanif B, Majeed AB. Therapeutic effects of ketogenic diet in the treatment of epilepsy. J Health Med Sci 2020;3(3):358-69. http://dx.doi.org/10.31014/aior.1994.03.03.131

Similar Articles

<< < 33 

You may also start an advanced similarity search for this article.