Ketogenic Diet Versus Immunological Therapy in the Management of Refractory Epilepsy in Children

In neuroclinical practice, refractory epilepsy can be identified only after the failure of several antiepileptic drugs (AEDs), so newer lines of treatment have been used, such as the ketogenic diet and rituximab.

A total of 105 patients with refractory epilepsy were divided into three equal groups, each receiving a specific treatment: group R received rituximab, group K received a ketogenic diet, and group S received steroids for six months. Seizure frequency was recorded before and after enrollment.

The age to start AEDs, the age at enrollment in the study, and the duration of use of AEDs were comparable among the three groups. Family history was the highest in rituximab and consanguinity was the highest in steroid but without significant statistical difference with p value 0.829 and 0.941 respectively. There was a significant improvement (in the form of fit reduction) in all groups with a p-value of <0.001. This percentage of change was higher in rituximab (42.9%), followed by ketogenic diet (30%), then steroid (21%). The presence of a positive family history of epilepsy had a significant effect on improvement using any line of treatment, with a p-value of 0.022. Patients with a positive family history of epilepsy or positive consanguinity or multiple types of convulsions showed significant improvements with ketogenic drugs compared to other patients, with p-values of 0.012, 0.044, and <0.001, respectively.

Adding rituximab or a ketogenic diet to patients with refractory epilepsy provides better control of fits, with percentage improvements of 42.9% and 30%, respectively.