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Efficacy of the ketogenic diet on ACTH- or corticosteroid-resistant infantile spasm: a multicentre prospective
Jie Zhang1, Guohong Chen2, Juan Wang3
1Department of Pediatrics, Peking University First Hospital, China.
Insights
Ketogenic diet therapy is more effective than adjusting antiepileptic drugs for infantile spasms (IS) resistant to ACTH or corticosteroids. This study found superior spasm reduction and hypsarrhythmia remission with ketogenic diet.
Area of Science:
- Pediatric Neurology
- Metabolic Therapies
- Epilepsy Research
Background:
- Infantile spasms (IS) are a severe epilepsy syndrome.
- Adrenocorticotropic hormone (ACTH) and corticosteroid resistance present treatment challenges.
- Ketogenic diet (KD) is an established therapy for refractory epilepsy.
Purpose of the Study:
- To evaluate the efficacy of ketogenic diet (KD) therapy for infantile spasms (IS) resistant to ACTH or corticosteroids.
- To identify factors associated with KD treatment outcomes in this population.
Main Methods:
- A prospective controlled study involving 227 patients across 10 centers in China.
- Patients were assigned to either KD therapy or a control group (adjusted antiepileptic drugs).
- Efficacy was assessed at 16 weeks based on spasm reduction and hypsarrhythmia remission (Grades I, II, III).
Main Results:
- Ketogenic diet therapy demonstrated superior efficacy compared to the control group (Grade II: 40.7% vs. 20.7%, p=0.025).
- A ketogenic ratio <3:1 was associated with a higher rate of Grade I response (66.7% vs. 33.3%, p=0.037).
- No significant correlation was found between KD efficacy and serum ketosis, IS etiology, or patient age.
Conclusions:
- Ketogenic diet therapy is more effective than adjusting oral antiepileptic drugs for ACTH- or corticosteroid-resistant infantile spasms.
- KD offers a promising alternative for managing refractory infantile spasms.
- Further research may explore optimal ketogenic ratios for specific patient subgroups.
Abstract:
To determine the efficacy of ketogenic diet (KD) therapy on adrenocorticotropic hormone- (ACTH) or corticosteroid-resistant infantile spasm (IS), and identify relevant associated factors. A prospective controlled study was undertaken at 10 tertiary children's medical centres in mainland China. Participants were non-randomly assigned to KD therapy or control (adjustment of antiepileptic drugs). The primary outcome was the reduction in spasms and remission of hypsarrhythmia at the 16th week, divided into Grade I (spasm-free for at least one week with hypsarrhythmia remission), Grade II (≥50% spasm reduction and/or hypsarrhythmia remission) and Grade III (<50% spasm reduction with hypsarrhythmia). In total, 227 patients were recruited and assigned to the KD (135 patients) and control (92 patients) groups. The efficacy in the KD group was superior to that in the control group (Grade I: 13.4% vs. 10.9%; Grade II: 40.7% vs. 20.7%, p=0.025). Patients with a ketogenic ratio <3:1 had a higher rate of Grade I than those with ketogenic ratio ≥3:1 (66.7% vs. 33.3%, p=0.037). No significant correlation was found between the efficacy of KD and level of serum ketosis, aetiology of IS, or age. The efficacy of KD therapy was superior to adjustment of oral antiepileptic drugs in children with ACTH- or corticosteroid-resistant infantile spasms.
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