Hsiu-Fen Lee1, Ching-Shiang Chi2, Jui-Hua Liao3. 1. Division of Pediatric Neurology, Children's Medical Center, Taichung Veterans General Hospital, 1650, Sec. 4, Taiwan Boulevard, Taichung 407, Taiwan; School of Medicine, Chung Shan Medical University, 110, Sec.1, Jianguo N. Rd., Taichung 402, Taiwan; Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, 79-9, Sha-Luen Hu, Xi-Zhou Li, Hou-Loung Town, Miaoli County 356, Taiwan. Electronic address: leehf@hotmail.com.tw. 2. Division of Pediatric Neurology, Department of Pediatrics, Tungs' Taichung Metroharbor Hospital, 699, Sec. 8, Taiwan Boulevard, Wuchi, Taichung 435, Taiwan; School of Medicine, Chung Shan Medical University, 110, Sec.1, Jianguo N. Rd., Taichung 402, Taiwan; Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, 79-9, Sha-Luen Hu, Xi-Zhou Li, Hou-Loung Town, Miaoli County 356, Taiwan. Electronic address: chi-cs@hotmail.com. 3. Department of Food and Nutrition, Taichung Veterans General Hospital, 1650, Sec. 4, Taiwan Boulevard, Taichung 407, Taiwan. Electronic address: jhfl@vghtc.gov.tw.
Abstract
BACKGROUND: In many parts of eastern Asia, rice is a dietary staple and therefore the ketogenic diet (KD) can be difficult to administer. The aim of this study was to assess the long-term effectiveness and tolerability of the classical KD using a 2:1 ratio of fat to protein plus net carbohydrates, which is lower than the ratios of 3:1 or 4:1 typically used in classical KD for intractable pediatric epilepsy. MATERIALS: In this prospective study, cooking oils rich in polyunsaturated fatty acid or omega 3 fatty acids, such as olive oil, camellia oil, linseed oil, grape seed oil, and/or perilla oil were used to formulate a classical KD with a 2:1 ratio for infants and children diagnosed with medically intractable epilepsy from April 2002 to April 2018. Subjects received the diet for at least 3 months. The efficacy of the diet was analyzed at 3, 6, 12, and 24 months, and at > 3 years. Tolerability during the period of diet administration was analyzed by medical records and parental reports. RESULTS: Sixty-three subjects, 29 males and 34 females, were enrolled from April 2002 to April 2018. The median age at diet initiation was 2 years 11 months. The median duration of adherence to the diet was 1 year 2 months. The seizure-free rate was 14%, 16%, 17%, 14%, and 14% at 3, 6, 12, and 24 months', and at > 3 years' follow-up, respectively. A greater than 50% seizure reduction was achieved in 52%, 43%, 40%, 33%, and 30% of subjects at each time point. The dietary compliance rate was 100%, 70%, 60%, 35%, and 27% at each follow-up time point. The reasons for discontinuation of the KD were the lack of further improvement in seizure frequency, seizure freedom achieved, food refusal, hyperlipidemia, and poor parental compliance in 38%, 11%, 5%, 2%, and 2% of subjects, respectively. Gastrointestinal discomfort was the most common adverse effect. CONCLUSION: The classical KD with a 2:1 ratio showed clinical effectiveness and tolerability in intractable pediatric epilepsy after long-term follow-up.
BACKGROUND: In many parts of eastern Asia, rice is a dietary staple and therefore the ketogenic diet (KD) can be difficult to administer. The aim of this study was to assess the long-term effectiveness and tolerability of the classical KD using a 2:1 ratio of fat to protein plus net carbohydrates, which is lower than the ratios of 3:1 or 4:1 typically used in classical KD for intractable pediatric epilepsy. MATERIALS: In this prospective study, cooking oils rich in polyunsaturated fatty acid or omega 3 fatty acids, such as olive oil, camellia oil, linseed oil, grape seed oil, and/or perilla oil were used to formulate a classical KD with a 2:1 ratio for infants and children diagnosed with medically intractable epilepsy from April 2002 to April 2018. Subjects received the diet for at least 3 months. The efficacy of the diet was analyzed at 3, 6, 12, and 24 months, and at > 3 years. Tolerability during the period of diet administration was analyzed by medical records and parental reports. RESULTS: Sixty-three subjects, 29 males and 34 females, were enrolled from April 2002 to April 2018. The median age at diet initiation was 2 years 11 months. The median duration of adherence to the diet was 1 year 2 months. The seizure-free rate was 14%, 16%, 17%, 14%, and 14% at 3, 6, 12, and 24 months', and at > 3 years' follow-up, respectively. A greater than 50% seizure reduction was achieved in 52%, 43%, 40%, 33%, and 30% of subjects at each time point. The dietary compliance rate was 100%, 70%, 60%, 35%, and 27% at each follow-up time point. The reasons for discontinuation of the KD were the lack of further improvement in seizure frequency, seizure freedom achieved, food refusal, hyperlipidemia, and poor parental compliance in 38%, 11%, 5%, 2%, and 2% of subjects, respectively. Gastrointestinal discomfort was the most common adverse effect. CONCLUSION: The classical KD with a 2:1 ratio showed clinical effectiveness and tolerability in intractable pediatric epilepsy after long-term follow-up.