Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Background: Although many children with epilepsy will have seizures controlled with antiepileptic drugs (AEDs), a large percentage of patients are refractory to drug therapy and may consider initiating a ketogenic diet (KD). The term Ketogenic Diet Therapy (KDT) refers to any diet therapy in which dietary composition results in a state of ketosis. Objectives: In this study we assessed the ef{uFB01}cacy, safety and tolerability of the KD in children with refractory epilepsy. Outcome predictive values of various clinical factors were also assessed. Methods: This is a prospective study of 40 children with refractory epilepsy, treated with KD at the clinical nutrition clinic of Cairo University Children Hospital between October 2018 and July 2019, and had continuous follow-up at 2, 4 and 6 months. The non-fasting protocol was followed without hospital admission. The classic KD with a ratio 2:1 or 3:1 (grams of fat to combined carbohydrate and protein) was used Results: The median age for the enrolled patients was 43.5 months (range, 5{u2013}137 months). Seizure frequency was assessed at 2, 4 and 6 months after KD initiation for 19, 3 and 18 patients respectively at the time of their last follow up visit. Nineteen (47.5%) patients achieved <50% seizure reduction (including 12 (30%) patients who became seizure free). Three (7.5%) patients achieved > 50% seizure reduction. Seizures increased in 4 (10%) patients while remained unchanged in 14 (35%) patients. Favorable treatment outcome was associated with longer duration on the KD (p-value< 0.001), grams of fat intake (p-value=0.020) and generalized slow background in pre-diet EEG findings (p-value=0.026). Frequently reported adverse effects included gastrointestinal disturbance, hyperlipidemia and food refusal

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