Efficacy and safety of the ketogenic diet therapy in Pakistani children with refractory epilepsy

OBJECTIVE: To find the effectiveness and tolerability of the ketogenic diet (KD) for Pakistani children with refractory epilepsy. METHODS: This study was conducted at Child Neurology Department, Children's Hospital & Institute of Child Health Multan, Pakistan. Data of diagnosed patients of refractory epilepsy, not responding to ≥2 antiepileptic drugs (AEDs), were well-tolerated, adequately utilized and received KD treatment from 2017 to 2020 was retrieved and analyzed. Data was analyzed through SPSS-23. RESULTS: Fifty-five children, including 18 (32.7%) girls and 37 (67.3%) boys, underwent KD initiation phase. Forty (72.7%) children received >2 AEDs. Fifteen (27.3%) children had >17 months’ duration of epilepsy. Type of epilepsy was undetermined in 25 (45.5%) cases, 14 (25.5%) had epileptic syndrome & 8 (14.5%) had progressive myoclonic epilepsy. Spasm (n=19, (34.5%), tonic (n=14; 25.5%) and tonic-clonic (n=7; 12.7%) were the commonest types of seizures. Out of 55 patients, 51 (92.7%), 39 (70.9%) & 24 (43.6%) patients continued CD for three, six and twelve months respectively. Seizure-free status at three, six and twelve months was achieved in 29.4% (n=15/51), 28.2% (n=11/39) and 25% (n=6/24) cases respectively. While >75% reduction in seizures at three, six and twelve months was observed in 31.4% (n=16 /51), 33.4% (n=13/39) and 29.1% (n=7/24) cases respectively. Common side effects included anorexia (n=30/55; 54.55%), diarrhea (n=12; 21.82%), kidney stones (n=7; 12.73%), and other side effects like constipation, hypoglycemia, ketoacidosis and gravel (n=6, 10.91%). CONCLUSION: KD combined with gradual commencement approaches is safe and effective therapy for Pakistani children with refractory epilepsy.