Ketogenic Diet Therapy in Infants: Efficacy and Tolerability

Area of Science:

• Neurology
• Pediatric Neurology
• Metabolic Disorders

Background:

• Intractable epilepsy in infants presents significant management challenges.
• Limited treatment options exist for medically refractory epilepsy in neonates and infants.
• The ketogenic diet is a recognized therapeutic option for pediatric epilepsy.

Purpose of the Study:

• To evaluate the tolerability and efficacy of the ketogenic diet in infants under 12 months of age.
• To assess the safety profile and success rates of ketogenic diet initiation in this vulnerable population.

Main Methods:

• Retrospective review of 27 infants under 12 months initiated on the ketogenic diet between 2007 and 2016.
• Data collected included epilepsy details, diet initiation, efficacy (responder rates, seizure freedom), and tolerability (adverse events).
• Infants were initiated on a traditional ketogenic diet at full caloric intake, primarily in-hospital.

Main Results:

• The ketogenic diet was initiated in 27 infants (median age 7 months) with a high prevalence of daily seizures and various epilepsy syndromes.
• Responder rates were high (68% at 1 month, 91% at 12 months), with 20-27% achieving seizure freedom by 12 months.
• Hypoglycemia occurred in two infants during initiation; overall tolerability was good, with most discontinuations due to lack of efficacy or loss to follow-up.

Conclusions:

• The ketogenic diet is an effective and well-tolerated treatment for intractable epilepsy in infants.
• In-hospital initiation is crucial for monitoring and managing potential adverse events like hypoglycemia.
• The diet offers a viable therapeutic strategy for improving seizure control in young infants with difficult-to-treat epilepsy.