Abstract
To evaluate the efficacy, safety, and tolerability of a classic 4:1 ketogenic diet using a formula-based powder in infants and children with refractory seizures who are reluctant to eat homemade foods. We conducted an open label trial and administered a ketogenic diet using formula-based power (Ketocal®). Twenty-seven infants and children aged between 12 months and 5 years were enrolled who had refractory seizures and were reluctant to eat homemade foods. Of 27 children, 5 were lost to follow-up and 22 were remained at the end of the study. After 4 months, the median frequency of seizures per week was reduced >50% in 68.2% of patients, while 9/22 children (40.9%) showed a 50–90% reduction in seizure frequency per week, and 6/22 children (27.3%) showed more than 90% reduction in seizure frequency per week. Over the study course, 6/22 (27%) children who continued to receive the diet developed constipation, one child developed gastroesophageal reflux, and one child developed hypercholesterolemia. None of these children discontinued the diet because of the complications. Thirteen children and their parents (59%) reported that the diet was palatable and tolerable enough. The ketogenic diet using a formula-based powder (Ketocal®) is effective, safe, and tolerable in infants and children with refractory seizures who are reluctant to eat homemade foods according to the rules of the ketogenic diet.
Similar content being viewed by others
References
Kossoff EH, Zupec-Kania BA, Rho JM (2009) Ketogenic diets: an update for child neurologists. J Child Neurol 24(8):979–988. doi:10.1177/0883073809337162
Keene DL (2006) A systematic review of the use of the ketogenic diet in childhood epilepsy. Pediatr Neurol 35(1):1–5. doi:10.1016/j.pediatrneurol.2006.01.005
Thammongkol S, Vears DF, Bicknell-Royle J, Nation J, Draffin K, Stewart KG, Scheffer IE, Mackay MT (2012) Efficacy of the ketogenic diet: which epilepsies respond? Epilepsia 53(3):e55–e59. doi:10.1111/j.1528-1167.2011.03394.x
Caraballo RH, Cersosimo RO, Sakr D, Cresta A, Escobal N, Fejerman N (2005) Ketogenic diet in patients with Dravet syndrome. Epilepsia 46(9):1539–1544. doi:10.1111/j.1528-1167.2005.05705.x
Coppola G, Verrotti A, Ammendola E, Operto FF, Corte RD, Signoriello G, Pascotto A (2010) Ketogenic diet for the treatment of catastrophic epileptic encephalopathies in childhood. Eur J Paediatr Neurol 14(3):229–234. doi:10.1016/j.ejpn.2009.06.006
Fejerman N, Caraballo R, Cersosimo R (2005) Ketogenic diet in patients with Dravet syndrome and myoclonic epilepsies in infancy and early childhood. Adv Neurol 95:299–305
Freeman JM, Vining EP, Pillas DJ, Pyzik PL, Casey JC, Kelly LM (1998) The efficacy of the ketogenic diet-1998: a prospective evaluation of intervention in 150 children. Pediatrics 102(6):1358–1363
Hong AM, Turner Z, Hamdy RF, Kossoff EH (2010) Infantile spasms treated with the ketogenic diet: prospective single-center experience in 104 consecutive infants. Epilepsia 51(8):1403–1407. doi:10.1111/j.1528-1167.2010.02586.x
Kossoff EH, Pyzik PL, McGrogan JR, Vining EP, Freeman JM (2002) Efficacy of the ketogenic diet for infantile spasms. Pediatrics 109(5):780–783
Lemmon ME, Terao NN, Ng YT, Reisig W, Rubenstein JE, Kossoff EH (2012) Efficacy of the ketogenic diet in Lennox-Gastaut syndrome: a retrospective review of one institution’s experience and summary of the literature. Dev Med Child Neurol 54(5):464–468. doi:10.1111/j.1469-8749.2012.04233.x
Maydell BV, Wyllie E, Akhtar N, Kotagal P, Powaski K, Cook K, Weinstock A, Rothner AD (2001) Efficacy of the ketogenic diet in focal versus generalized seizures. Pediatr Neurol 25(3):208–212
Nabbout R, Copioli C, Chipaux M, Chemaly N, Desguerre I, Dulac O, Chiron C (2011) Ketogenic diet also benefits Dravet syndrome patients receiving stiripentol: a prospective pilot study. Epilepsia 52(7):e54–e57. doi:10.1111/j.1528-1167.2011.03107.x
Nabbout R, Mazzuca M, Hubert P, Peudennier S, Allaire C, Flurin V, Aberastury M, Silva W, Dulac O (2010) Efficacy of ketogenic diet in severe refractory status epilepticus initiating fever induced refractory epileptic encephalopathy in school age children (FIRES). Epilepsia 51(10):2033–2037. doi:10.1111/j.1528-1167.2010.02703.x
Kang HC, Kim YJ, Kim DW, Kim HD (2005) Efficacy and safety of the ketogenic diet for intractable childhood epilepsy: Korean multicentric experience. Epilepsia 46(2):272–279. doi:10.1111/j.0013-9580.2005.48504.x
Zamani GR, Mohammadi M, Ashrafi MR, Karimi P, Mahmoudi M, Badv RS, Tavassoli AR, Azizi Malamiri R (2016) The effects of classic ketogenic diet on serum lipid profile in children with refractory seizures. Acta Neurol Belg. doi:10.1007/s13760-016-0601-x
Cross JH, Neal EG (2008) The ketogenic diet—update on recent clinical trials. Epilepsia 49(Suppl 8):6–10. doi:10.1111/j.1528-1167.2008.01822.x
Freeman JM, Kossoff EH, Hartman AL (2007) The ketogenic diet: one decade later. Pediatrics 119(3):535–543. doi:10.1542/peds.2006-2447
Nordli DR Jr, Kuroda MM, Carroll J, Koenigsberger DY, Hirsch LJ, Bruner HJ, Seidel WT, De Vivo DC (2001) Experience with the ketogenic diet in infants. Pediatrics 108(1):129–133. doi:10.1542/peds.108.1.129
Rubenstein JE (2008) Use of the ketogenic diet in neonates and infants. Epilepsia 49(Suppl 8):30–32. doi:10.1111/j.1528-1167.2008.01829.x
Acknowledgements
This paper is from the thesis of Seyed Ahmad Hosseini, M.D., registration number (IRCT20121001690N5). Nutricia company and the Research Deputy of Tehran University of Medical Sciences provided financial and logistic support for this study (IRCT20121001690N5) but had no role in study design; data collection, analysis, or interpretation; writing the report; or in the decision to submit the article for publication. The authors are grateful to all parents and patients for their participation in this study. We are extremely indebted to the authorities of Research Deputy of Tehran University of Medical Sciences and Nutricia Company especially Mr Abdullah Cem Atay and Mrs Mojdeh Zohari for their financial support and providing the Ketocal® formulas and the staff of the nutrition ward of the Children’s Medical Center for their kind cooperation.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all parents of children included in the study.
Rights and permissions
About this article
Cite this article
Ashrafi, M.R., Hosseini, S.A., Zamani, G.R. et al. The efficacy of the ketogenic diet in infants and young children with refractory epilepsies using a formula-based powder. Acta Neurol Belg 117, 175–182 (2017). https://doi.org/10.1007/s13760-016-0732-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13760-016-0732-0