Ketogenic diets in the treatment of children with severe epilepsy: clinical efficacy and metabolic effects.

There is little information on the clinical efficacy or the mechanism of action of ketogenic diets in the treatment of children with epilepsy. We have studied 22 children (age range 6/12-15 years) with intractable epilepsy on normal diet (ND) and then on one of two ketogenic diets - the 'Classical Diet' (CD) (4:1 fat:carbohydrate and protein) or Medium Chain Triglyceride Diet (MCTD) (60% daily calories as MCT oil). Poth diets were effective in reducing seizure frequency; overall, 68% of children studied had > 90% reduction in seizures. 10 of 12 children on the CD and 11 of 15 on the MCTD had > 50% decrease in seizures. Tne marked clinical improvement did not correlate with the EEG. There were minimal side effects, and anti-convulsant medication could be reduced, blood glucose, acetoacetate β-hydroxybutyrate and alanine levels were measured during a 24 hour period on normal and therapeutic diets. Mean blood glucose concentration did not change. Increased mean blood ketone body levels occurred on CD and MCTD (3.12 + ).25 mmol/1 and 1.53 + 0.10 mmol/1 respectively v.s. 0.21 + 0.03 mmol/1 on ND). Mean blood alanine level was significantly reduced on CD (0.22 + 0.003 mmol/1 v.s. 0.340 + 0.016 mmol/1 on ND). We conclude that ketogenic diets are highly effective in treating selected children with severe epilepsy. Several possible mechanisms of effect are suggested by the metaholic studies.