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Risk of seizure recurrence after achieving initial seizure freedom on the ketogenic diet

Katherine S Taub1, Sudha Kilaru Kessler, A G Christina Bergqvist

  • 1Division of Neurology, Departments of Pediatrics and Neurology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.

Epilepsia
|March 29, 2014
PubMed

Insights

Seizure recurrence after ketogenic diet (KD) therapy is common but usually mild. Most children who achieve seizure freedom on the KD experience only occasional breakthrough seizures, not a return to baseline.

Area of Science:

  • Pediatric Neurology
  • Epilepsy Management
  • Dietary Therapies

Background:

  • The long-term sustainability of seizure freedom with the ketogenic diet (KD) is not well-established.
  • Few studies have assessed seizure recurrence after initial success on the KD.

Purpose of the Study:

  • To evaluate the risk of seizure recurrence in children who achieved at least one month of seizure freedom on the KD.
  • To identify clinical features associated with sustained seizure freedom on the KD.

Main Methods:

  • Retrospective review of pediatric patients on KD from 1991-2009.
  • Inclusion criteria: at least one month of seizure freedom within two years of KD initiation.
  • Comparison of patients with seizure freedom <1 year vs. ≥1 year.

Main Results:

  • 24% of patients (65/276) achieved ≥1 month seizure freedom.
  • Seizure recurrence occurred in 82% of these patients (53/65) within a median of 3 months.
  • Post-recurrence seizure frequency remained significantly lower than baseline.

Conclusions:

  • Seizure recurrence after initial KD success is common but typically presents as infrequent breakthrough seizures.
  • The KD remains a viable treatment option for epilepsy, even after initial seizure freedom is lost.
  • No specific clinical features predicted seizure recurrence risk.
Abstract

Keywords:
ChildrenKetogenic dietMedication-resistant epilepsySeizure freedom

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