The Ketogenic Diet: A 3- to 6-Year Follow-Up of 150 Children Enrolled Prospectively
[Articles] Hemingway, Cheryl MB ChB; Freeman, John M. MD; Pillas, Diana J. BA; Pyzik, Paula L. BA
From the Johns Hopkins Medical Institutions, Baltimore, Maryland. Dr Hemingway was the 1999 Roxanne Fellow in Pediatric Epilepsy at Johns Hopkins.
Received for publication Nov 21, 2000; accepted Mar 21, 2001. Reprint requests to (J.M.F.) Meyer 2-147, Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287-7247. E-mail: John Freeman
ABSTRACT.
Objective. To document the long-term outcome of the 83 children with difficult-to-control seizures who were enrolled prospectively in a study of the efficacy of the ketogenic diet and who had remained on the diet for 1 year.
Methods. A total of 150 consecutive children were entered prospectively into a study of the ketogenic diet's efficacy and tolerability. Three to 6 years after diet initiation, all 150 families were sent a survey inquiring about their child's current health status, seizure frequency, and current anticonvulsant medications. They were asked about their experience with the diet and reasons for discontinuation. Several telephone attempts were made to contact those who did not respond to the written questionnaire. Responses were entered in an Access database and analyzed.
Results. In 1999, 3 to 6 years after initiating the diet, 107 of 150 families responded to a questionnaire. Thirty-five additional families were interviewed by telephone, 4 were lost to follow-up, and 4 children had died, unrelated to the diet. Of the original 150 patient cohort, 20 (13%) were seizure-free and an additional 21 (14%) had a 90% to 99% decrease in their seizures. Twenty-nine were free of medications, and 28 were on only 1 medication; 15 remained on the diet. There were no known cardiac complications.
Conclusion. Three to 6 years after initiation, the ketogenic diet had proven to be effective in the control of difficult-to-control seizures in children. The diet often allows decrease or discontinuation of medication. It is more effective than many of the newer anticonvulsants and is well-tolerated when it is effective.
Effects of ketogenic diet on development and behavior: Preliminary report of a prospective study Developmental Medicine and Child Neurology; London; May 2001Volume: 43(5):301; Margaret B Pulsifer;Julie M Gordon;Jason Brandt;Eileen PG Vining;John M Freeman;
The ketogenic diet is increasingly used for the management of difficult-to-control seizures in children. Here, we describe the first prospective study of the effects of the diet on development, behavior, and parenting stress. Participants were 65 children (36 males, 29 females) with intractable seizures, ages 18 months to 14 years 6 months, enrolled in a prospective study at the Johns Hopkins Hospital, Baltimore, MD, USA, to study the diet's efficacy. Children were assessed before diet initiation and at 1-year follow-up. At follow-up, 52% (34 of 65) children remained on the diet. Mean seizure frequency decreased from 25 per day before diet initiation to less than two per day I year later. At follow-up, mean developmental quotient showed statistically significant improvement with significant behavioral improvements in attention and social functioning. Parental stress was essentially unchanged. No baseline factor examined predicted diet adherence, and the primary reason for diet discontinuation was insufficient seizure control. These preliminary results support prior anecdotal reports of the beneficial effects of the diet on cognition and behavior.
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