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Published on: September 20, 2024
Decreased relative efficacy of the ketogenic diet for children with surgically approachable epilepsy
Rebecca S Stainman1, Zahava Turner, James E Rubenstein
1Department of Neurology and Pediatrics, The John M. Freeman Pediatric Epilepsy Center, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Insights
For children with epilepsy treatable by surgery, the ketogenic diet can reduce seizures. However, surgery offers a higher chance of seizure freedom compared to diet alone.
Area of Science:
- Pediatric Neurology
- Epilepsy Research
- Dietary Therapies
Background:
- The ketogenic diet is a recognized treatment for intractable childhood epilepsy.
- Surgery is also a common intervention for surgically approachable epilepsy in children.
- The comparative efficacy of these two treatment modalities is not fully established.
Purpose of the Study:
- To compare the efficacy of the ketogenic diet versus surgery in children with surgically approachable epilepsy.
- To evaluate seizure reduction and freedom rates in pediatric epilepsy patients undergoing different treatment pathways.
Main Methods:
- Retrospective chart review of 554 children on the ketogenic diet.
- Comparison of 24 children who underwent resective surgery with 45 matched controls not candidates for surgery.
- Analysis of seizure frequency, duration on diet, and seizure freedom rates.
Main Results:
- Children receiving both surgery and the ketogenic diet showed significantly higher seizure reduction (>90%) and seizure freedom rates at 6 months compared to diet alone (71% vs 17% and 63% vs 0%, respectively).
- The surgical cohort demonstrated a higher likelihood of seizure freedom post-intervention.
- Non-surgical candidates on the diet had shorter diet adherence durations compared to the surgical group.
Conclusions:
- While the ketogenic diet is effective in reducing seizures in children with surgically approachable epilepsy, surgery leads to a higher probability of seizure freedom.
- Surgical intervention should be strongly considered for pediatric epilepsy patients with surgically approachable focal epilepsy.
Purpose:
In children with intractable, surgically approachable epilepsy, the ketogenic diet is often perceived as less efficacious than surgery.
Methods:
A retrospective chart review was performed of 554 children started on the ketogenic diet since 1994. Forty-five children were identified as surgical candidates, with at least 2 focal routine EEGs, ictal video-EEG, and corresponding focal neuroimaging findings, of whom 24 eventually had resective surgery and were followed subsequently. A comparison cohort group was also created of 45 children matched for age and seizure frequency that received the diet but were not surgical candidates (multifocal or generalized seizures).
Results:
Of the 24 children who received both dietary and surgical therapies, there was a higher likelihood after 6 months of both >90% seizure reduction (71% versus 17%) and seizure freedom (63% versus 0%) following surgery, both p < 0.0001. Similarly, the 45 cohort children who were not surgical candidates were more likely to be seizure-free (29% versus 13%, p = 0.041) and remained on the diet for shorter duration (10 months versus 18 months, p = 0.035) compared to the surgical group.
Conclusion:
Children with surgically approachable epilepsy do respond to the diet, but are more likely to be seizure-free following surgery.
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