Assessment and follow up of the children with refractory epilepsy on ketogenic diet

Introduction: The ketogenic diet is a method of treatment that is recommended for patients with epilepsy who have not responded to medications. The present study was designed to evaluate the efficacy of the ketogenic diet along with follow-up on drug resistant epilepsy in children referred to medical centers affiliated to Shiraz University of Medical Sciences. Methods: This study was a multicenter prospective evaluation of a clinical intervention in 61 children with drug resistant epilepsy. Participants were included in the study by convenience sampling. According to the patient's age and the dietitian's diagnosis, each individual was treated with one of the types of the ketogenic diet and was followed up for one year. Patients were examined in terms of gender, age, weight, maternal education level, duration and type of seizures, medication use, surgical history, developmental and cognitive status, side effects at the onset and duration of the ketogenic diet, parents' satisfaction with the effect of the diet, duration of following the diet, and reasons for discontinuation of the diet. Finally, the obtained data were analyzed using descriptive statistics methods. Results: 73.8 percent of the parents were satisfied with the effects of the ketogenic diet on improving drug resistant epilepsy in their child. In addition, following this diet resulted in improved cognitive status in 42.6 percent of cases and reduction of anticonvulsants in 18.1 percent of cases. About 40 percent of the participants experienced no adverse effects either initially or during the implementation of the ketogenic diet. In others, fatigue at the onset of the diet and constipation during the diet were the most commonly observed adverse effects. Unfortunately, only 19.7 percent of the patients continued the ketogenic diet for 6-12 months. The main reason for early discontinuation of this diet was reported to be the lack of mother's or child's cooperation due to implementation difficulty and unpleasant taste. Conclusions: Our findings confirm the beneficial effects of the ketogenic diet on the improvement of drug resistant epilepsy in children and propound a necessity to apply strategies for improving the compliance with and adherence to this diet in the study area.