Implementation of ketogenic diet in children with drug-resistant epilepsy in a medium resources setting: Egyptian experience.
Level 4 - case-series / case-control
Retrospective case series without a comparison group
PubMed 30619711 · doi:10.1016/j.ebcr.2018.11.001
What was done
Medical records were retrospectively reviewed for 28 children (median age 60 months, range 30 to 110) with intractable epilepsy treated at Cairo University Children's Hospital between December 2012 and March 2014. Patients were initiated on an outpatient, non-fasting classic ketogenic diet (ratio 2.5:1 to 4:1) and followed at 1, 3, and 6 months to evaluate retention and seizure control.
What was found
At 1 month, 16 of 28 patients (57%) remained on the diet. Among these 16, 7 (43.8%) had at least a 50% reduction in seizure frequency (1 patient with over 90% reduction and 6 with 50% to 90% reduction). Three patients stopped the diet after month 1 despite achieving 50% to 90% seizure reduction. At 3 months, 6 patients (22%) remained on the diet, with 4 of 6 (66.7%) achieving at least 50% seizure reduction. At 6 months, 3 patients remained on the diet; 2 had 50% to 90% reduction and 1 had greater than 90% reduction.
Why it matters
This study shows that an outpatient classic ketogenic diet protocol is feasible in a medium-resource setting, though high attrition is a major obstacle to long-term efficacy.
Limits
Single-center retrospective design with a small sample (n = 28) and no comparison group. Attrition was severe, with nearly 90% of children discontinuing by 6 months. Adverse effects, tolerability measures, and specific reasons for diet discontinuation were not reported in the abstract.
Cited by
- supports The classical ketogenic diet used for drug-resistant epilepsy consists of approximately 85% to 90% fat and 8% to 10% protein.