Original articleInfluence of the Ketogenic Diet on 24-Hour Electroencephalogram in Children With Epilepsy
Introduction
The ketogenic diet is used to treat medically resistant epilepsy in children [1]. It is a high-fat, low-carbohydrate diet usually extracting energy from fat related to energy from carbohydrates and protein at a ratio of 4:1. It effectively reduces the number of seizures [2], and seems to affect all types of seizures [2], [3], even if there seems to be a slightly better effect on generalized compared with partial seizures [3], [4]. Many mechanisms of action were described [5], and they are still not fully understood. Both an antiseizure effect and an antiepileptogenic effect were proposed [6]. Furthermore, effects on cognition and behavior were observed [7].
In the framework of understanding its effects, the influence of the ketogenic diet on interictal and ictal electroencephalogram activity is of interest. The information obtained so far is rather limited regarding electroencephalogram changes during treatment with the ketogenic diet [8], [9], [10], [11], [12], [13], [14]. Usually, these reports contain information from routine short electroencephalograms before and during treatment.
In this study, we evaluated the changing electroencephalogram pattern in 23 children treated with the ketogenic diet, using 24-hour electroencephalogram recordings prior to starting the diet, and again after 3 months of treatment. Qualitative and semiquantitative evaluations of all recordings focused on background activity, interictal epileptiform discharges, and ictal epileptiform activity. The electroencephalogram pattern after introduction of the diet was related to seizure reduction and to a quality-of-life evaluation using a visual analog scale.
Section snippets
Patients
The present study was part of a larger prospective, open trial on the efficacy and safety of the ketogenic diet in children with epilepsy. The children were enrolled in the study consecutively while they attended the Epilepsy Outpatient Department of Karolinska Hospital (Stockholm, Sweden), and the ketogenic diet was initiated because of pharmacologically refractory epilepsy. The study was conducted at the Department of Neuropediatrics of Karolinska Hospital. The study was approved by the
Results
Seizure reduction was >50% for 16 of 23 patients (responders), and <50% for 7 of 23 patients (nonresponders). Response related to age of onset, seizure type, or etiology was not possible to evaluate statistically because of the small number of patients in each group. However, response was significantly more likely than nonresponse in those with a duration of epilepsy <5 years before treatment (12 of 14 such children were responders; sign test positive, P = 0.05). The quality-of-life evaluation,
Discussion
In this study, we made qualitative and semiquantitative evaluations of changes in 24-hour electroencephalogram patterns when recordings were compared before and after starting the ketogenic diet. The recordings were concealed to the electroencephalogram reader upon evaluation. During the period between examinations, minor reductions of habitual antiepileptic drug doses were undertaken. These changes are usually not reported to influence electroencephalogram activity.
Comparing
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