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Efficacy and Safety of Ketogenic Dietary Therapies in Infancy

Published in Seizure: European Journal of Epilepsy, August 2021

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Ketogenic dietary therapies (KDT) are effective treatments for children with drug-resistant epilepsy. The use of KDT in infants carries an additional burden of ensuring that the diet meets nutritional requirements in this critical phase of growth and development. To offer their insight, a centre in Spain (Niño Jesús Paediatric Hospital, Madrid) has recorded their experience of supporting infants with epilepsy and the assessment on effectiveness, side effects, growth and nutritional status using KDT. 

This is a retrospective, observational study in which medical records of infants (<2 years old) on a KDT from 2000-2018 were reviewed. Demographic data was recorded as well as the effectiveness of the KDT measured by a reduction in ineffective antiseizure medicines  and seizures versus baseline (100% (seizure free), 90% -100%, 50%-90%, <50%, 0% (no improvement), or increase in seizures). 

Forty-two infants were started on a KDT, of which the median age at the beginning of symptoms was 3.9 months and the median age at onset of KDT was 7.7 months. All infants started the diet as an inpatient and the types of KDT started were classic ketogenic diet ratio (g fat: g carbohydrate plus protein) (3:1) (n40); ratio (4:1) (n1) and modified ketogenic diet with MCT (n1). The mean length of time on the KDT was 390 days (16 days-4.9 years). KDT was effective (seizure reduction >50%) in half of the infants in the first 6 months. Seizure control was excellent (>90%) in more than a quarter of infants and some were seizure free. Early adverse effects during the first month occurred in 40% of infants and included asymptomatic hypoglycaemia (9/42) and gastrointestinal disturbances (4/42). See paper for full effectiveness data and adverse effect data.

This paper shares crucial insights into the complex nutritional therapy of KDT in infants. In their experience, KDT are effective, safe, and although adverse effects are common, they are generally manageable. Close monitoring is essential to ensure nutritional adequacy and growth.