Ketogenic Diet in Refractory Childhood Epilepsy: Starting With a Liquid Formulation in an Outpatient Setting

Area of Science:

• Pediatric Neurology
• Metabolic Therapies
• Epilepsy Management

Background:

• The ketogenic diet significantly impacts the daily lives of children with epilepsy, typically requiring long-term adherence.
• Evaluating novel ketogenic diet formulations is crucial for improving patient outcomes and adherence.

Purpose of the Study:

• To assess the feasibility of initiating an all-liquid ketogenic diet in an outpatient setting for children with refractory epilepsy.
• To determine if an all-liquid ketogenic diet allows for earlier assessment of treatment efficacy compared to traditional methods.

Main Methods:

• A prospective, observational study involving 16 children (aged 2-14 years) with refractory epilepsy.
• The ketogenic diet was initiated using an all-liquid formulation (KetoCal 4:1 LQ), administered orally or via tube, followed by conversion to solid meals at 6 weeks.
• Primary outcome: time-to-response (>50% seizure reduction); Secondary outcomes: time to stable ketosis, response rate, and 26-week retention.

Main Results:

• Median time-to-response was 14 days (range 7-28 days) in 4 responders.
• Stable ketosis was achieved in a mean of 7 days.
• The 26-week retention rate was 50%; 6 of 8 orally fed children completed the protocol without nasogastric tube intervention.

Conclusions:

• Initiating a ketogenic diet with a liquid formulation is feasible in orally fed children, presenting no major complications.
• The liquid ketogenic diet facilitates rapid achievement of stable ketosis, suggesting potential for earlier efficacy evaluation.