Jm. Freeman et Epg. Vining, Seizures decrease rapidly after fasting - Preliminary studies of the ketogenic diet, ARCH PED AD, 153(9), 1999, pp. 946-949
Objectives: To evaluate the change in atonic or myoclonic seizures associat
ed with the Lennox-Gastaut syndrome during the initiation of the ketogenic
diet, and. to describe the development of a blinded crossover study of the
efficacy of the ketogenic diet.
Design: A before-after trial.
Setting: The Johns Hopkins Hospital, Baltimore, Md.
Patients: Change in clinical seizure frequency was examined in 17 consecuti
vely treated patients with atonic or myoclonic seizures. In a few patients,
a 24-hour ambulatory electroencephalogram was obtained before and after di
et initiation. We demonstrated the ability to manipulate the ketosis induce
d by fasting with the addition of glucose (dextrose) in 1 patient.
Interventions: Children fasted for 36 hours, and the diet was gradually int
roduced over 3 days. Parents were instructed to keep a baseline seizure fre
quency calendar for the month before the initiation of the diet. These cale
ndars continued to be maintained as the diet was initiated.
Main Outcome Measure: Seizure decrease from baseline. Results: The atonic o
r myoclonic seizures decreased in these children by more than 50% immediate
ly. Using a 24-hour ambulatory electroencephalogram, we documented that the
seizures reported by a parent represent only a fraction of the electroclin
ical events; the technique could be used to measure the profound decrease i
n electrically documented seizures. Ketosis was eliminated with glucose, 60
g/d.
Conclusions: It is feasible to evaluate the ketogenic diet's efficacy in at
onic or myoclonic seizures in a blinded, crossover study. The diet can be m
anipulated on a shortterm basis in a blinded manner, and ketosis can be ach
ieved or eliminated.