Highlights
- •Ketogenic diet therapies (KDT) are an essential treatment option for drug-resistant epilepsy in adult patients.
- •The application of KDT among adult patients with refractory epilepsy is challenging due to multi-factorial reasons.
- •Developing strategies to enhance compliance might significantly increase the number of patients who could benefit from this treatment.
Abstract
Background
Ketogenic diet therapies (KDT) are appropriate therapeutic options for pediatric and
adult patients with intractable epilepsy. The application of KDT among adult patients
with refractory epilepsy is limited compared to children for several reasons, including
poor compliance. We present the significant reasons for the lack of adherence to KDT
in our adult patients with intractable epilepsy.
Methods
This study was conducted retrospectively in adult patients with drug-resistant epilepsy
who were offered and accepted to implement KDT between 2014 and 2021. Demographic and clinical data were collected via electronic
health records. The eventual outcome of KDT results was obtained from the consultant
dietitian. The prevalence and reasons for the failure to implement KDT were investigated.
We also obtained detailed information about patients who successfully applied the
KDT.
Results
A total of 33 patients (18F; median age 28) who were offered and accepted to implement KDT were included. Baseline seizure frequency was
>4 per week in 49%, and more than half of the patients used >3 anti-seizure medications
(ASM). Epilepsy types were temporal in 10 (30%), extratemporal in 10 (30%), generalized
in 6 (18%), and unclassified in 7 (22%) patients. Only 3 patients (9%) were able to maintain KDT in the long term. One of them (33%)
benefited from this therapy. In the remaining 30 patients, the reasons for failure were inability to contact the
dietitian in 5, failure to apply KDT for a particular reason in 7, inappropriate blood
test results or any medical/surgical comorbidities in 6, improvement in seizure burden
due to change in ASM in 5, still insufficient knowledge of KDT in 3, unresponsiveness
to diet due to incorrect implementation in 1 and unidentified reasons in 3 patients.
Conclusions
A significant percentage of adult patients with refractory seizures failed to use
KDT in our study (91%). Strategies to improve compliance and minimize the side effects might increase the
number of drug-refractory epilepsy patients who could benefit from this therapy.
Keywords
Abbreviations:
ASM (Anti-seizure medications), cKDT (Classic ketogenic diet therapy), DRIs (Dietary Reference Intakes), GABA (γ-aminobutyric acid), IQR (Interquartile range), KD (Ketogenic diet), KDT (Ketogenic diet therapies), LGIT (Low glycemic index treatment), MAD (Modified Atkins diet), MCT (Medium-chain triglyceride), WHO (World Health Organization)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 14, 2023
Accepted:
April 23,
2023
Received in revised form:
April 22,
2023
Received:
February 16,
2023
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
