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Original Contribution
November 1998

A Multicenter Study of the Efficacy of the Ketogenic Diet

Author Affiliations

From The Johns Hopkins Medical Institutions, Baltimore, Md (Drs Vining and Freeman); Montefiore Medical Center, Bronx, NY (Dr Ballaban-Gil); Dalhousie University, IWK Grace Health Centre, Pediatric Neurology, Halifax, Nova Scotia (Drs C. S. Camfield and P. R. Camfield); Children's Hospital, Boston, Mass (Dr Holmes); Montefiore Medical Center, Albert Einstein College of Medicine, Bronx (Dr Shinnar); Comprehensive Epilepsy Center, University of Kentucky College of Medicine, Kentucky Clinic, Lexington (Dr Trevathan); and the Department of Neurology, University of Texas Medical School, Houston (Dr Wheless). Dr Shuman is in private practice in Mishawaka, Ind.

Arch Neurol. 1998;55(11):1433-1437. doi:10.1001/archneur.55.11.1433

Objective  To determine the efficacy of the ketogenic diet in multiple centers.

Design  A prospective study of the change in frequency of seizures in 51 children with intractable seizures who were treated with the ketogenic diet.

Setting  Patients were enrolled from the clinical practices of 7 sites. The diet was initiated in-hospital and the patients were followed up for at least 6 months.

Patients  Fifty-one children, aged 1 to 8 years, with more than 10 seizures per week, whose electroencephalogram showed generalized epileptiform abnormalities or multifocal spikes, and who had failed results when taking at least 2 appropriate anti-epileptic drugs.

Intervention  The children were hospitalized, fasted, and a 4:1 ketogenic diet was initiated and maintained.

Main Outcome Measures  Frequency of seizures was documented from parental calendars and efficacy was compared with prediet baseline after 3, 6, and 12 months. The children were categorized as free of seizures, greater than 90% reduction, 50% to 90% reduction, or lower than 50% reduction in frequency of seizures.

Results  Eighty-eight percent of all children initiating the diet remained on it at 3 months, 69% remained on it at 6 months, and 47% remained on it at 1 year. Three months after initiating the diet, frequency of seizures was decreased to greater than 50% in 54%. At 6 months, 28 (55%) of the 51 initiating the diet had at least a 50% decrease from baseline, and at 1 year, 40% of those starting the diet had a greater than 50% decrease in seizures. Five patients (10%) were free of seizures at 1 year. Age, sex, principal seizure type, and electroencephalogram were not statistically related to outcome.

Conclusion  The ketogenic diet is effective in substantially decreasing difficult-to-control seizures and can successfully be administered in a wide variety of settings.