Elodie Stenger1, Mickael Schaeffer1, Claude Cances2, Jacques Motte3, Stéphane Auvin4, Dorothée Ville5, Hélène Maurey6, Rima Nabbout7, Anne de Saint-Martin8. 1. Hôpital Universitaire de Strasbourg, Centre de Référence des Epilepsies Rares, France. 2. Hôpital Universitaire de Toulouse, France. 3. Hôpital Universitaire de Reims, France. 4. Hôpital Robert Debré, Paris, France. 5. Hôpital Universitaire de Lyon, Paris, France. 6. Hôpital du Kremlin Bicêtre, Paris, France. 7. Hôpital Necker Enfants Malades, Centre de Référence des Epilepsies Rares, Paris, France. 8. Hôpital Universitaire de Strasbourg, Centre de Référence des Epilepsies Rares, France. Electronic address: anne.desaintmartin@chru-strasbourg.fr.
Abstract
OBJECTIVE: Recent studies have suggested that the early introduction of a ketogenic diet (KD) could improve seizure control in myoclono-astatic epilepsy (MAE). This multicenter study sought to identify the benefits of KD use on seizure control and epilepsy and on developmental outcomes in children with resistant MAE. METHODS: Fifty children who were diagnosed with severe MAE in the French network of Reference Centers for Rare Epilepsies and who were treated with KD between 2000 and 2013 were included in this study. The seizure frequency and EEG recordings were assessed two weeks before KD introduction, 2 and 6 months after, and during the last follow-up, which also included an assessment of developmental outcome. RESULTS: Patients had a median follow up of 52 months (range 13-136) and received 4.3 antiepileptic drugs [2-9] before KD introduction. Fifty-four percent (54%) of our patients were seizure-free after 6 months of KD or more, and 86% experienced more than a 70% seizure reduction after 2 months of KD. Forty-four percent (44%) of them had a clear benefit of early KD treatment (after four AEDs failed). Early KD treatment did not result in a greater seizure reduction (p=0.055), but significantly resulted in remission (p<0.028). Fifty percent of patients with resistant MAE had normal development outcomes. Earlier KD treatment, after three AEDs failed, was correlated with a better cognitive outcome (p<0.01). SIGNIFICANCE: Early introduction of KD treatment in resistant MAE has a strong, persistent anticonvulsant effect with long-term remission and better cognitive outcomes.
OBJECTIVE: Recent studies have suggested that the early introduction of a ketogenic diet (KD) could improve seizure control in myoclono-astatic epilepsy (MAE). This multicenter study sought to identify the benefits of KD use on seizure control and epilepsy and on developmental outcomes in children with resistant MAE. METHODS: Fifty children who were diagnosed with severe MAE in the French network of Reference Centers for Rare Epilepsies and who were treated with KD between 2000 and 2013 were included in this study. The seizure frequency and EEG recordings were assessed two weeks before KD introduction, 2 and 6 months after, and during the last follow-up, which also included an assessment of developmental outcome. RESULTS:Patients had a median follow up of 52 months (range 13-136) and received 4.3 antiepileptic drugs [2-9] before KD introduction. Fifty-four percent (54%) of our patients were seizure-free after 6 months of KD or more, and 86% experienced more than a 70% seizure reduction after 2 months of KD. Forty-four percent (44%) of them had a clear benefit of early KD treatment (after four AEDs failed). Early KD treatment did not result in a greater seizure reduction (p=0.055), but significantly resulted in remission (p<0.028). Fifty percent of patients with resistant MAE had normal development outcomes. Earlier KD treatment, after three AEDs failed, was correlated with a better cognitive outcome (p<0.01). SIGNIFICANCE: Early introduction of KD treatment in resistant MAE has a strong, persistent anticonvulsant effect with long-term remission and better cognitive outcomes.
Authors: Ara Ko; Da E Jung; Se H Kim; Hoon-Chul Kang; Joon S Lee; Seung T Lee; Jong R Choi; Heung D Kim Journal: Front Neurol Date: 2018-07-16 Impact factor: 4.003