| Purposes Ketogenic diet (KD) is a nonpharmacologic treatment strategy to control refractory epilepsy in children. Since the time of the bible, fasting has been used in the treatment of convulsion and epilepsy. The concept of KD was gradually put forward in the1920s. Then the KD was used in treating epilepsy and was gradually use in other diseases. As the new antiepileptic drugs (AEDs) constantly emerged, KD gradually lost the attention of people. Although a large number of AEDs were widely used, about a third of patients were still not effectively controlled. The KD secondarily retuned to the sight of people and was widely used to treat the refractory epilepsy in children. Recently the mechanism of KD is in the study. Studies on the efficacy of long-term using of KD, tolerability of KD and its possible side effects after long-term using of KD are constantly reported. This paper is to evaluate the long-term efficacy of KD and tolerability as well as its possible adverse reactions.Methods Children with refractory epilepsy who were treated with KD between May,2011and March,2013in our hospital were selected. In reference of the classic KD of the Johns Hopkins hospital, we formulated our own classic KD that suited our hospital and treated the patients with it. Data from these children had follow-up of at least one month after initiation of the KD. The efficacy of KD should be analysed retrospectively. Response was defined as≥50%seizure reduction. In this paper, we evaluate the influence of KD on EEG and the development of nervous system, analize the influence of gender, age at epilepsy onset, etiology, family history and AEDs on the effect of KD.Results73children were included in our study, but3existed in the early time of KD for many reasons(one case had a terrible diarrhoea, one refused to eat, the last one was because KD was uneffective), so there are33girls and37boys with mean age38.5months±32. Mean follow-up was6.65months±3.87. Following-up more than3months,30/57(53%) of the patients were responders.10/57(18%) of them were seizure free.27/57(47%) were non-responders. In responders, EEG background activity improved significantly. Epileptic discharges greatly decreased. The cognition and mental development of them were gradually improved.The controversy between the efficacy of KD and disease duration was still alive. According to our study, the efficacy of KD in male was better than that in female. But there was no statistically significance. The effect of KD for focal seizure was poorer.15/35(43%) patients with infant spasm (IS) was response,7/15(47%) of patients with epilepsy which types were unknown was effective. It was effective in2cases of Lennox-Gastaut syndrome (LGS) and2cases of Doose syndrome. lcase(1/2,50%) of epilepsy secondary to tuberous sclerosis was always seizure free after treated with KD. Now he had returned to normal diet.The side effects of KD included that13cases(19%) had diarrhea,16cases(23%)had vomiting,11cases(11%) had constipation,4cases(6%) had hypoglycemia,4cases(6%) had infection. Treated with KD for more than3months later,4cases (6%) had hypoalbuminemia,4cases(6%) had hyperlipidemia,1case(1%) had fatty liver disease, and1case(1%) had kidney stones. But all of those did no affect the normal running of KD after symptomatic treatment, compensating albumin, reducing the proportion of KD, drinking more water and promptly rechecking. KD still continue.Conclusion The effect of KD in treating refractory epilepsy in children is obvious. It can not only reduce the epilepsy seizure, but also can significantly improve patients’ EEG and promote the development of patients’ nervous system and improve their cognition. In addition the side effect of KD is not lethal, but can be tolerated. It is obvious that KD will be an ideal therapy for children with refractory epilepsy. |
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