Ketogenic diet for infantile spasms refractory to first-line treatments: An open prospective study

• Published in: Epilepsy research 2013-07, Vol.105 (1), p.189-194
• Main Authors: Pires, Maria Elisa, Ilea, Adina, Bourel, Emilie, Bellavoine, Vanina, Merdariu, Dana, Berquin, Patrick, Auvin, Stéphane
• Format: Article
• Language: English
• Subjects: Anticonvulsants. Antiepileptics. Antiparkinson agents; Biological and medical sciences; Cohort Studies; Diet, Ketogenic - methods; Diseases of the nervous system; Felbamate; Female; Follow-Up Studies; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Infant; Infantile spasms; Ketogenic diet; Male; Medical sciences; Metabolic diseases; Metals (hemochromatosis...); Nervous system (semeiology, syndromes); Neurology; Neuropharmacology; Other metabolic disorders; Pharmacology. Drug treatments; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Spasms, Infantile - diagnosis; Spasms, Infantile - diet therapy; Topiramate; Treatment Outcome
• ISSN: 0920-1211; 1872-6844
• DOI: 10.1016/j.eplepsyres.2012.11.009

Summary Ketogenic diet (KD) is an efficient treatment for refractory epilepsy including infantile spasms (IS). We evaluated the effect of a KD to treat IS as a third-line treatment, after vigabatrin (VGB) and steroids. We evaluated the efficacy and the tolerability of KD in IS using the rate of seizure-free patients at 1 month. Methods We conducted an open study using the data from a prospective database of two French child neurology departments (Amiens & Robert Debré-Paris, France) over a three-year period. All the patients followed the KD for 6 months. The addition of an antiepileptic drug was allowed after 1 month of KD in the non-seizure-free patients. Results 17 patients were treated by KD for IS. The KD was initiated at the mean age of 9.4 ± 1.1 months. After 1 month with KD, 6/17 (35%) patients were seizure free while 11/17 (65%) were seizure-free after the third month. However, an additional antiepileptic drug (felbamate or topiramate) was given to all patients that were not seizure-free under KD. The KD was well tolerated. Conclusion Our responder rate is similar to previous studies despite an early use (before 1-year-old) and the use of KD after VGB and steroids. The KD was well-tolerated in this population of young infants. Felbamate leads to an increase in the responder rate after the use of KD.