PURPOSE: This study examines electroencephalographic (EEG) changes in children with medication resistant epilepsy treated with the ketogenic diet (KD). METHODS: Routine EEGs were obtained prior to KD initiation, then one month and three months later. Changes in EEG background slowing and frequency of interictal epileptiform discharges (IEDs) were evaluated using power spectrum analysis and manual determination of spike index. KD responders were compared to non-responders to determine if baseline or early EEG characteristics predicted treatment response (>50% seizure reduction) at three months. RESULTS: Thirty-seven patients were evaluated. No differences in baseline EEG features were found between responder groups. Frequency of IEDs declined in 65% of patients as early as one month, by a median of 13.6% (IQR 2-33). Those with a ten percent or greater improvement in IED frequency at one month were greater than six times more likely to be KD responders (OR 6.5 95% CI 0.85-75 p=0.03). Qualitative and quantitative measures of EEG background slowing improved in the whole cohort, but did not predict responder status. CONCLUSION: Baseline predictors of KD response remain elusive. Most patients experienced a reduction in IEDs and improvement in EEG background slowing after KD initiation. Reduction of IEDs at one month strongly predicted KD responder status at three months.
PURPOSE: This study examines electroencephalographic (EEG) changes in children with medication resistant epilepsy treated with the ketogenic diet (KD). METHODS: Routine EEGs were obtained prior to KD initiation, then one month and three months later. Changes in EEG background slowing and frequency of interictal epileptiform discharges (IEDs) were evaluated using power spectrum analysis and manual determination of spike index. KD responders were compared to non-responders to determine if baseline or early EEG characteristics predicted treatment response (>50% seizure reduction) at three months. RESULTS: Thirty-seven patients were evaluated. No differences in baseline EEG features were found between responder groups. Frequency of IEDs declined in 65% of patients as early as one month, by a median of 13.6% (IQR 2-33). Those with a ten percent or greater improvement in IED frequency at one month were greater than six times more likely to be KD responders (OR 6.5 95% CI 0.85-75 p=0.03). Qualitative and quantitative measures of EEG background slowing improved in the whole cohort, but did not predict responder status. CONCLUSION: Baseline predictors of KD response remain elusive. Most patients experienced a reduction in IEDs and improvement in EEG background slowing after KD initiation. Reduction of IEDs at one month strongly predicted KD responder status at three months.
Authors: Khoi D Than; Eric H Kossoff; James E Rubenstein; Paula L Pyzik; Jane R McGrogan; Eileen P G Vining Journal: Epilepsia Date: 2005-04 Impact factor: 5.864
Authors: A G Christina Bergqvist; Joan I Schall; Paul R Gallagher; Avital Cnaan; Virginia A Stallings Journal: Epilepsia Date: 2005-11 Impact factor: 5.864
Authors: Elizabeth G Neal; Hannah Chaffe; Ruby H Schwartz; Margaret S Lawson; Nicole Edwards; Geogianna Fitzsimmons; Andrea Whitney; J Helen Cross Journal: Lancet Neurol Date: 2008-05-02 Impact factor: 44.182
Authors: Eric H Kossoff; Beth A Zupec-Kania; Per E Amark; Karen R Ballaban-Gil; A G Christina Bergqvist; Robyn Blackford; Jeffrey R Buchhalter; Roberto H Caraballo; J Helen Cross; Maria G Dahlin; Elizabeth J Donner; Joerg Klepper; Rana S Jehle; Heung Dong Kim; Y M Christiana Liu; Judy Nation; Douglas R Nordli; Heidi H Pfeifer; Jong M Rho; Carl E Stafstrom; Elizabeth A Thiele; Zahava Turner; Elaine C Wirrell; James W Wheless; Pierangelo Veggiotti; Eileen P G Vining Journal: Epilepsia Date: 2008-09-23 Impact factor: 5.864
Authors: John M Freeman; Eileen P G Vining; Eric H Kossoff; Paula L Pyzik; Xiaobu Ye; Steven N Goodman Journal: Epilepsia Date: 2008-08-19 Impact factor: 5.864
Authors: Eric H Kossoff; Beth A Zupec-Kania; Stéphane Auvin; Karen R Ballaban-Gil; A G Christina Bergqvist; Robyn Blackford; Jeffrey R Buchhalter; Roberto H Caraballo; J Helen Cross; Maria G Dahlin; Elizabeth J Donner; Orkide Guzel; Rana S Jehle; Joerg Klepper; Hoon-Chul Kang; Danielle A Lambrechts; Y M Christiana Liu; Janak K Nathan; Douglas R Nordli; Heidi H Pfeifer; Jong M Rho; Ingrid E Scheffer; Suvasini Sharma; Carl E Stafstrom; Elizabeth A Thiele; Zahava Turner; Maria M Vaccarezza; Elles J T M van der Louw; Pierangelo Veggiotti; James W Wheless; Elaine C Wirrell Journal: Epilepsia Open Date: 2018-05-21