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Effect of a ketogenic diet on decrease of seizures in refractory epilepsy among children (infancy to 14 years old) in
Leena R Baghdadi1, Renad A Alhomaidi2, Fatimah S Alhelal2
1Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Insights
Ketogenic diets show promise for treating refractory epilepsy in children. Higher diet ratios (3:1, 4.5:1) and physical activity improved seizure frequency, while parental education and income also influenced outcomes.
Area of Science:
- Pediatric Neurology
- Metabolic Therapies
- Epilepsy Management
Background:
- Refractory epilepsy in children is defined by persistent disabling seizures despite anti-seizure drug trials.
- Ketogenic diets are an established treatment for refractory seizures globally, but underutilized in Saudi Arabia.
- This study investigates ketogenic diet efficacy and influencing factors in Saudi children with refractory epilepsy.
Purpose of the Study:
- To examine the relationship between ketogenic diet exposure and seizure frequency reduction in pediatric refractory epilepsy.
- To identify factors associated with improved seizure outcomes in children on ketogenic diets.
- To assess the impact of diet ratios, physical activity, and sociodemographic factors on seizure control.
Main Methods:
- A cross-sectional study was conducted at King Fahad Medical City, Riyadh, Saudi Arabia.
- Medical records of 95 children (10 months to 14 years) with refractory epilepsy on ketogenic diets were reviewed.
- Parental socioeconomic data were collected via phone interviews.
Main Results:
- Children on higher ratio ketogenic diets (3:1 and 4.5:1) experienced decreased seizure frequency (up to 44%).
- Patients with generalized epilepsy (56.1%) and ambulatory patients (66.7%) showed the most significant seizure outcome improvements.
- Lower seizure improvement was linked to lower parental education, lower income, and later age of seizure diagnosis (>8 years).
Conclusions:
- Ketogenic diets are a viable and promising treatment for pediatric refractory epilepsy.
- Higher ketogenic diet ratios and increased physical activity correlate with better seizure control.
- Parental education, income, and patient mobility are significant factors influencing treatment success.
Background:
Refractory (intractable/pharmaco-resistant) epilepsy in children is considered if disabling seizures continue despite appropriate trials of two anti-seizure drugs, either alone or in combination. Ketogenic diets are used as a treatment option in many countries for children with refractory seizures; however, few patients have tried it in Saudi Arabia. Therefore, we examined the relationship between the exposure to a ketogenic diet and its effect in decreasing seizure frequency in infants and children up to 14 years who had refractory epilepsy and assessed factors that could improve the outcome of seizures.
Methods:
This cross-sectional study was conducted at King Fahad Medical City, Riyadh, Saudi Arabia. Data were collected by reviewing medical records of eligible children (infants and children up to 14 years old) with refractory epilepsy who were on ketogenic diets. Socioeconomic data of the parents (guardians) were collected via phone interviews after verbal consent from the parents (guardians).
Results:
We recruited 95 children (aged 10 months to 14 years) with refractory epilepsy and on Ketogenic diets. Up to 44% of patients on 3:1 and 4.5:1 ratio ketogenic diets had decreased seizure frequency while patients on 1:1 and 2:1 ratio ketogenic diets showed no decrease in seizures. Patients with generalized epilepsy who were on ketogenic diets had the most improvement in seizure outcomes (56.1%) and patients on ketogenic diets who were ambulatory indoors and outdoors (66.7%) showed a high level of improvement in seizure outcomes compared to patients with who were non-ambulatory (21.9%). Lower improvements in seizure frequency in epileptic patients on ketogenic diets were associated with low education levels of parents (33.3% high school vs. 50% undergraduate school), low incomes [<11,400±7,560.864 Saudi riyal (SR)], and diagnosis of seizures in patients >8 years old.
Conclusions:
Ketogenic diets are a promising approach for treatment of refractory epilepsy among children. The improvement in seizure outcomes was associated with higher ratios of ketogenic diets (3:1 and 4.5:1), and higher physical activity. Sociodemographic factors, including parents' (guardians') education levels and income influenced the improvement of seizures.
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