A ketogenic diet (search) that burns fat rather than sugar for energy may be safe to start outside a hospital setting for children with difficult-to-treat epilepsy, according to a new study.
Researchers say the ketogenic diet has been used in the treatment of epilepsy for more than 80 years, but it wasn't clear whether starting the diet as a part of an outpatient treatment program was safe or practical for children with the disease.
The ketogenic diet is very high in fats and low in carbohydrates and mimics the effects of starvation. But the diet must be rigidly controlled when used in epilepsy treatment because any deviation may trigger a seizure.
In this study, researchers compared the effectiveness and safety of the ketogenic diet in a group of 54 children with epilepsy who went through the initiation phase of the diet either in or outside a hospital.
Researchers found no evidence that starting the ketogenic diet as an inpatient provided any additional benefits. There were no significant differences between the two groups in terms of reducing seizures and improving alertness and social interaction.
"Our study shows that it's possible to begin the diet safely as an outpatient and maintain it without restricting fluids as done in other centers," says researcher Jeffrey Buchhalter, MD, of the pediatric epilepsy program at the Mayo Clinic in Rochester, Minn., in a news release. "For parents with children who have epilepsy, it means potentially fewer days of lost work while the diet is initiated and more comfort for their child. However, we do recommend that these findings need to be confirmed in a prospective study."
Ketogenic Diet Safe for Home Use in Treating Epilepsy
In the study, researchers examined the medical records of 54 children with epilepsy who used the ketogenic diet as part of their epilepsy treatment. Nearly half of the children had some form of mental retardation, 80 percent had multiple types of seizures, and they had unsuccessfully tried an average of about five antiepileptic drugs (search).
Thirty-seven of the children started the ketogenic diet as outpatients, and 17 started the ketogenic diet while in the hospital. The results appear in the September issue of Pediatric Neurology.
Researchers found 62 percent of those who started the ketogenic diet as outpatients and 71 percent of those who started as inpatients experienced a greater than 50 percent improvement in seizure control. Both groups also showed improvement in alertness and social interaction.
The researchers say that the benefits of starting the ketogenic diet as an outpatient include greater acceptance and ability to maintain and comply with the diet. It also reduces the expense and inconvenience for many parents.
However, they say inpatient initiation programs may be preferable to some families who favor the intense educational process that patients receive when starting the ketogenic diet in the hospital.
By Jennifer Warner, reviewed by Brunilda Nazario, MD
SOURCES: Vaisleib, I. Pediatric Neurology, September 2004; vol 31: pp 198-202. News release, Mayo Clinic.
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