Risk of seizure recurrence after achieving freedom on the ketogenic diet

My most recent post on the ketogenic diet was meant to convey one possible treatment approach for those cases where seizures had not been controlled by medication. Although the ketogenic diet usually provides for improvements in seizure control, the same is not regarded as a primary intervention. Compared to many anticonvulsants the ketogenic diet has few side effects. One possible explanation for this paradox (high efficacy, few side effects but low use of an intervention) is the fact that many physicians lack training and understanding in regards to the ketogenic diet. Another factor that may play a role into implementing a ketogenic diet is that it requires a lot of effort and possible collaboration with a nutritionist or dietician. For those interested in the subject I will be posting more blogs in the future. In the meanwhile, I just discovered this article when reviewing the literature on PubMed: Taub KS1, Kessler SK, Bergqvist AG. Risk of seizure recurrence after achieving initial seizure freedom on the ketogenic diet. Epilepsia. 2014 Apr;55(4):579-83. doi: 10.1111/epi.12583. Epub 2014 Mar 27.

I am reproducing the Abstract in the next few paragraphs:
OBJECTIVE: Few studies have examined the long-term sustainability of complete seizure freedom on the ketogenic diet (KD). The purpose of this study was to describe the risk of seizure recurrence in children who achieved at least 1 month of seizure freedom on the KD, and to assess clinical features associated with sustained seizure freedom.
METHODS: Records of patients initiated on the KD at The Children’s Hospital of Philadelphia (CHOP) from 1991 to 2009 were reviewed. Subjects who attained seizure freedom for at least 1 month within 2 years were included in the study. Seizure frequency was recorded based on caregiver-reported seizure diaries as unchanged, improved, or worse compared to baseline. Those patients with seizure freedom ≥1 year were compared to those with seizure freedom <1 year in terms of demographics, age of seizure onset, number of antiepileptic drugs (AEDs) prior to KD, and epilepsy classification.
RESULTS: Of 276 patients initiated on the KD, 65 patients (24%) attained seizure freedom for a minimum of 1 month. The majority of these patients had daily seizures. The median time to seizure freedom after KD initiation was 1.5 months. Seizures recurred in 53 patients (82%), with a median time to seizure recurrence of 3 months. However, seizure frequency after initial recurrence remained far less than baseline. No clinical features were identified as risk factors for seizure recurrence.
SIGNIFICANCE: Seizure recurrence on the KD after 1 month of seizure freedom most often occurred as occasional breakthrough seizures and not a return to baseline seizure frequency. This study provides evidence to support the continued use of the KD in patients with initial seizure freedom even after breakthrough seizures. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.

The whole article can be obtained from: http://onlinelibrary.wiley.com/doi/10.1111/epi.12583/pdf

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