TY - JOUR
T1 - Ketogenic diet for the treatment of pediatric epilepsy
T2 - review and meta-analysis
AU - Sourbron, Jo
AU - Klinkenberg, Sylvia
AU - van Kuijk, Sander M. J.
AU - Lagae, Lieven
AU - Lambrechts, Danielle
AU - Braakman, Hilde M. H.
AU - Majoie, Marian
N1 - Funding Information:
We would like to thank Dr. Adri Voogd for his supportive comments on the manuscript. Funding information LL receives research funding, speakers, and advisory board honoraria: Zogenix, UCB, Shire, Novartis, Eisai.
Publisher Copyright:
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2020/6
Y1 - 2020/6
N2 - The ketogenic diet (KD), containing high levels of fat and low levels of carbohydrates, has been used to treat refractory epilepsy since the 1920s. In the past few decades, there has been more interest in less restrictive KDs such as the modified Atkins diet (MAD). Purpose Our aim was to review all evidence regarding the efficacy and tolerability of the KD and MAD from randomized controlled trials (RCTs) in children and adolescents with refractory epilepsy. Methods We reviewed the current literature using Cochrane, EMBASE, and MEDLINE (using PubMed). We implemented predefined criteria regarding dataextraction and study quality. Results We identified five RCTs that generated seven publications and recruited 472 children and adolescents with refractory epilepsy (= 50%) was attained in 35-56.1% of the participants in the intervention group, compared with 6-18.2% in the control group. Our meta-analysis underlined the significant efficacy of the KD compared with the control group: RR = 5.1 (95% CI 3.18-8.21, p <0.001). Additionally, only two studies mentioned possible biomarkers to objectively evaluate the efficacy. Secondary outcomes, such as seizure severity and quality of life, were studied in three trials, leading to indecisive generalization of these findings. Gastro-intestinal adverse effects were the most prevalent, and no severe adverse effects were reported. Conclusion Despite the heterogeneity between all studies, the beneficial results underline that dietary interventions should be considered for children and adolescents with refractory epilepsy who are not eligible for epilepsy surgery. Future studies should be multi-center and long-term, and evaluate potential biomarkers and adverse effects.
AB - The ketogenic diet (KD), containing high levels of fat and low levels of carbohydrates, has been used to treat refractory epilepsy since the 1920s. In the past few decades, there has been more interest in less restrictive KDs such as the modified Atkins diet (MAD). Purpose Our aim was to review all evidence regarding the efficacy and tolerability of the KD and MAD from randomized controlled trials (RCTs) in children and adolescents with refractory epilepsy. Methods We reviewed the current literature using Cochrane, EMBASE, and MEDLINE (using PubMed). We implemented predefined criteria regarding dataextraction and study quality. Results We identified five RCTs that generated seven publications and recruited 472 children and adolescents with refractory epilepsy (= 50%) was attained in 35-56.1% of the participants in the intervention group, compared with 6-18.2% in the control group. Our meta-analysis underlined the significant efficacy of the KD compared with the control group: RR = 5.1 (95% CI 3.18-8.21, p <0.001). Additionally, only two studies mentioned possible biomarkers to objectively evaluate the efficacy. Secondary outcomes, such as seizure severity and quality of life, were studied in three trials, leading to indecisive generalization of these findings. Gastro-intestinal adverse effects were the most prevalent, and no severe adverse effects were reported. Conclusion Despite the heterogeneity between all studies, the beneficial results underline that dietary interventions should be considered for children and adolescents with refractory epilepsy who are not eligible for epilepsy surgery. Future studies should be multi-center and long-term, and evaluate potential biomarkers and adverse effects.
KW - Epilepsy
KW - Drug-resistant
KW - Ketogenic diet
KW - Modified Atkins diet
KW - Meta-analysis
KW - MODIFIED ATKINS DIET
KW - GLYCEMIC INDEX TREATMENT
KW - REFRACTORY EPILEPSY
KW - CHILDHOOD EPILEPSY
KW - ILAE COMMISSION
KW - TASK-FORCE
KW - CHILDREN
KW - EFFICACY
KW - ADOLESCENTS
KW - MANAGEMENT
U2 - 10.1007/s00381-020-04578-7
DO - 10.1007/s00381-020-04578-7
M3 - (Systematic) Review article
C2 - 32173786
SN - 0256-7040
VL - 36
SP - 1099
EP - 1109
JO - Child's Nervous System
JF - Child's Nervous System
IS - 6
ER -