Effects of ketogenic diet on epileptiform activity in children with therapy resistant epilepsy
Tove Hallböök1, Sven Köhler, Ingmar Rosén
1Department of Clinical Sciences, Division of Paediatrics, University Hospital, SE-221 85 Lund, Sweden. tove.hallbook@skane.se
Insights
The ketogenic diet significantly reduced epileptiform discharges in children with epilepsy, particularly during sleep. This reduction correlated with fewer clinical seizures, showing the diet
Area of Science:
- Pediatric Neurology
- Neurophysiology
- Metabolic Therapies
Background:
- Therapy-resistant epilepsy in children presents significant challenges.
- The ketogenic diet (KD) is an established treatment for drug-resistant epilepsy.
- Understanding KD's impact on epileptiform activity and clinical outcomes is crucial.
Purpose of the Study:
- To quantify changes in epileptiform activity during KD treatment in children with therapy-resistant epilepsy.
- To evaluate the relationship between these changes and activity stages.
- To assess correlations with seizure frequency, severity, attention, quality of life (QOL), and beta-hydroxybutyrate (betaOHb) levels.
Main Methods:
- Ambulatory EEG monitoring (24h) was conducted 1 week before and 3 months after KD initiation in 18 children.
- Automated spike detection was used to evaluate epileptiform activity.
- Data was compared with previous sleep structure and clinical outcome data from the same cohort.
Main Results:
- A significant reduction in interictal epileptiform discharges (IEDs) was observed after 3 months of KD (p<0.001).
- IED reduction was significant during non-REM sleep stage 2, slow-wave sleep (SWS), and REM sleep.
- Increased beta-hydroxybutyrate (betaOHb) levels correlated with improved attentional behavior (Spearman r=0.5, p=0.03).
Conclusions:
- The ketogenic diet effectively reduces epileptiform discharges, especially during sleep, in children with therapy-resistant epilepsy.
- A correlation exists between reduced epileptiform activity and decreased clinical seizure frequency.
- No significant correlation was found between reduced epileptiform activity and improvements in QOL or attention, though increased betaOHb correlated with better attention.
Purpose:
The purpose was to quantify changes of epileptiform activity during ketogenic diet (KD) treatment in children with therapy resistant epilepsy, and evaluate how these changes are related to activity stage and to clinical effects on seizure frequency, seizure severity, attentional behaviour, quality of life (QOL), and beta-hydroxybutyrate (betaOHb).
Methods:
Eighteen children were investigated with 24h ambulatory EEG monitoring 1 week prior to KD initiation and, after 3 months of KD treatment. Epileptiform activity was evaluated by automated spike detection. This data was compared with data presented in a previous study published in Epilepsia 2006, on sleep structure and different activity stages, clinical data on seizure frequency, seizure severity, QOL and attentional behaviour on the same children [Hallbook, T., Lundgren, J., Rosén, I., 2007. Ketogenic diet improves sleep quality in children with therapy resistant epilepsy. Epilepsia 48, 59-65].
Results:
After 3 months of KD treatment the number of interictal epileptiform discharges (IEDs) was significantly reduced (p<0.001). When considering the four activity stages separately, the reduction was significant during non-rapid eye movement sleep stage 2, slow wave sleep (SWS) and rapid eye movement (REM) sleep (p=0.001, 0.001, 0.002), and not significantly so during awake (p=0.07). Beta-hydroxybutyrate was significantly increased (p<0.001). There was a significant correlation between the reduction in IEDs and clinical seizures (Spearman r=0.6, p=0.005) and between improvement in attentional behaviour and the increase in betaOHb (Spearman r=0.5, p=0.03). There was no significant correlation between changes in attentional behaviour and IEDs or clinical seizures.
Conclusion:
This study shows that KD reduces the number of IEDs, especially during sleep. It shows a correlation between reduction in epileptiform activity and clinical seizures. There were no correlations between reduction in epileptiform activity and clinical seizures and improvement in QOL or attention. The increase in betaOHb correlated with improvement in attention.
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