Ketogenic diet for epilepsy gets mixed reviews.
Researchers from the University of Missouri--Kansas City (UMKC), for example, reported that adhering to a ketogenic diet (KGD) reduced the number of emergency department visits and hospitalizations, and decreased the length of epilepsy-related hospital stays in children with pharmacologically refractory epilepsy.
In 98 children from the Children's Mercy Hospital--UMKC database who had complete records available and who remained on the diet for at least 6 months, the number of ED visits decreased by 64%, and the charges asso-dated with those visits decreased by 50% from the 12 months before diet initiation to the 12 months after, Dr. Anastasia Luniova reported in a poster at the meeting.
After an initial increase in the total number of hospitalizations and the number of hospital days, due largely to stays associated with diet initiation, the number of hospitalizations decreased by 61% and the number of hospital days decreased by 66%. Associated charges decreased by 47%.
Children in this retrospective chart study from a level IV pediatric epilepsy center induded 62 boys and 36 girls with an average age of 4.4 years at initiation of the ketogenic diet. The average diet duration was 31.7 months. "This study provides evidence that the KGD has a positive impact in children with pharmacologically refractory epilepsy by reducing the number of ED visits, numbers of hospitalizations, as well as length of hospital stay related to epilepsy, and associated comorbidities. ... Further data analysis is necessary for detailed cost-effectiveness assessment of the KGD," Dr. Luniova wrote.
The KGD was also safe and effective in a study of 10 adults with refractory status epilepticus, Dr. John C. Probasco of Johns Hopkins University, Baltimore, reported in a poster.
While further studies are needed to determine the applicability of a KGD in adult patients, as well as the longterm outcomes, the findings suggest it is safe and feasible, Dr. Probasco said.
The retrospective case study at four medical centers included patients over age 17 years with status epilepticus that continued tor at least L4 flours alter initiation of general anesthetic medication, or that recurred following weaning from, or discontinuation of, the treatment. The patients, including four men and six women, had a median age of 33 years, and seven had encephalitis. Prior to KGD initiation, the median duration of status epilepticus was 21.5 days, and the median number of antiepileptic drugs (AEDs) used was seven. Nine of the 10 patients achieved ketosis within a median of 3 days, and all patients had cessation of status epilepticus within 3 days. Furthermore, seven had clinical and/or electrographic seizure resolution within 7 days, and nine had such resolution within 1 month. At discharge, the median number of antiepileptic drugs prescribed was four, Dr. Probasco reported.
Another study demonstrated the beneficial effects of a KGD on immunoglobulin levels and infection frequency.
In addition to its known side effects, the [KGD] is considered to lead to an increase in infection frequency causing possible neutrophil function impairment and the reason behind this has not yet been explained completely," wrote Dr. Orkide Gtizel of Izmir (Turkey) Dr. Behcet Uz Children's Hospital.
But a review of the records of 36 children with resistant epilepsy, including 17 girls and 19 boys with a mean age of 395 months, showed no significant differences with respect to the number and severity of infections before and after KGD initiation, and immunoglobulin levels remained normal for the patients' ages. At the same time, their number of seizures and AED usage decreased. Epileptic encephalopathy in five patients also went away after KGD treatment.
However, several other studies found that in children, the diet may be linked with decreases in growth and bone health.
Delayed growth is considered a potential side effect of the KGD, and UMKC researchers set out to assess growth related to caloric intake in infants and children being treated with a KGD. In another retrospective chart study of 76 children at Children's Mercy Hospital, Kansas City, mean weight-and height-for-age percentiles and z scores declined over a period of 12 months, though not statistically signifi-candy, Dr. Lindsey Thompson of Children's Mercy reported in a poster.
Another study found a significant risk of developing osteopenia among patients on a KGD, compared with matched controls.
Of 132 children included in the retrospective matched cohort study, 66 were treated with AEDs and a KGD (initiated at a mean age of 4.3 years), and 66 were treated with AEDs alone.
The KGD group had fractures--often unrelated to trauma--more often than did those on AEDs alone (14% vs. 8%, respectively). The incidence of both osteopenia and fractures increased in tandem with the duration of the KGD, according to the group of investigators from the University of British Columbia, Vancouver, led by Dr. Mary B. Connolly.
There was a history of trauma in one-third of the KGD patients with fracture, compared with 100% of those in the AED-only group. In addition, all patients in the KGD group had osteopenia, compared with 60% of those in the control group. "Our results suggest that prolonged treatment with the KD may be associated with significant morbidity; including osteopenia and fractures," Dr. Connolly wrote.
The findings, which support those of prior long-term studies, suggest that monitoring of bone health and vitamin D and calcium supplementation is important in this population, she said.
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|Publication:||Clinical Psychiatry News|
|Date:||Feb 1, 2014|
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