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Efficacy of the ketogenic diet for infantile spasms
Eric H Kossoff1, Paula L Pyzik, Jane R McGrogan
1Department of Neurology, Pediatric Epilepsy Center, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. ekossoff@jhmi.edu
Insights
The ketogenic diet shows promise as a safe and effective treatment for infantile spasms, improving seizure control and development in young children. Many patients experienced significant seizure reduction and were able to decrease medication use.
Area of Science:
- Neurology
- Pediatric Neurology
- Dietary Therapies
Background:
- Infantile spasms are a severe form of epilepsy in infants.
- Current treatments for infantile spasms have limitations and varying efficacy.
- The ketogenic diet is a high-fat, low-carbohydrate diet used therapeutically.
Purpose of the Study:
- To evaluate the safety, tolerability, and efficacy of the ketogenic diet for treating infantile spasms.
- To assess seizure reduction, developmental improvements, and adverse events associated with the diet.
Main Methods:
- A retrospective analysis of 23 children (5 months to 2 years) with infantile spasms treated with the ketogenic diet.
- Assessment of seizure reduction using parent reports and electroencephalograms (EEGs).
- Evaluation of medication changes, developmental progress, and diet-related adverse events.
Main Results:
- Significant seizure reduction was observed, with 46-53% of patients achieving >90% improvement at 9-12 months.
- Developmental improvement correlated with seizure control, observed in 57% of patients.
- The diet was well-tolerated, with 56% remaining on it at 12 months; 7 children experienced mild adverse reactions.
Conclusions:
- The ketogenic diet is a safe and well-tolerated therapeutic option for infantile spasms.
- It demonstrates potential efficacy in reducing seizures and improving development.
- Further research may establish the ketogenic diet as a valuable alternative therapy.
Objective:
The objective of this study was to determine whether the ketogenic diet is safe, well-tolerated, and efficacious in the treatment of infantile spasms.
Methods:
During a 4-year period, 23 children with infantile spasms, aged 5 months to 2 years, were started on the ketogenic diet; 9 (39%) had symptomatic infantile spasms, and 16 (70%) had hypsarrhythmia. Children had an average prediet exposure to 3.3 anticonvulsants. Two children were enrolled before any medication had been tried. Seizure reduction was analyzed retrospectively, using parent reports and electroencephalograms (EEGs) when available.
Results:
At 3, 6, 9, and 12 months, 38%, 39%, 53%, and 46%, respectively, of all patients currently on the diet were >90% improved (3 were seizure-free at 12 months); 67%, 72%, 93%, and 100% were >50% improved. Fifty-six percent remained on the diet at 12 months, 46% of whom were >90% improved and 100% were >50%. Fifty percent of those with hypsarrhythmia and follow-up EEGs had EEG improvement. Fifty-seven percent had their medications reduced or discontinued by 12 months. Fifty-seven percent had improvement in development, which was correlated with seizure control. Independent factors that predicted improvement included age younger than 1 year and previous exposure to 3 or fewer anticonvulsants. No child has died, and 7 children had diet-related adverse reactions (nephrolithiasis, gastroesophageal reflux).
Discussion:
The ketogenic diet is a safe, well-tolerated, and possibly effective potential alternative to other therapies for infantile spasms.