Abstracts

Rationale: The Classic (CKD) and the Medium Chain Triglyceride (MCTKD) ketogenic diets (KD) are equally effective in controlling seizures. While the exact mechanism of the KD is not known, it has been observed that urinary ketone levels correlate with seizure control. Previously, we demonstrated that urine ketones are significantly higher on the CKD compared with the MCTKD suggesting an independent anticonvulsant role for MCT oil. The MCTKD is only prescribed orally but the CKD is fed either orally or enterally. Enteral feeding is a more exact method of administering the diet, possibly confounding our data. We compare seizure frequency and ketone levels between orally-fed children on either a CKD or MCTKD. Methods: A prospective observational cohort study was initiated at the Hospital for Sick Children, Toronto, Canada in September 2013, including all consented children starting a KD for the treatment of medication-resistant epilepsy. Seizure types and frequency, diet specifics and ketone production were recorded by caregiver and collected by study staff at 1, 3 and 6 months post diet initiation. Six-month outcomes were calculated, including mean urine ketones and mean percentage of baseline seizures and compared among those children treated with an orally-fed CKD or the MCTKD. Children who stopped the diet before 6 months were excluded from the analysis but are described below. Results: Thirty six children initiated a KD during the study period, however 11 children (6 girls; mean age 5.60 yo SD 5.39,) were excluded because they either did not follow a diet or opted out of the study before 6 months. Five of these 11 (45%) children were G-tube fed and 7 (63%) followed the CKD. At 6 months, data for 12 children taking the diet orally was available; 5 followed a CKD and 7 a MCTKD. The mean age of our group was 4.42 y.o. (SD 3.26) and 5 (41.6%) were male. Eleven (92%) of the 12 patients had generalized convulsive seizures. Mean urine ketone level was 8.09 mmol/L (SD4.25) and the mean percentage of baseline seizures at 6 months was 24.60% (SD 37.28). There were no significant differences in the MCTKD and CKD groups for age, gender and seizure type. At 6-month follow-up, mean urine ketones were significantly higher in the children treated with the CKD; 11.72 mmol/L (SD3.78) on the CKD and 5.49 mmol/L (SD 2.18) on the MCTKD (p=0.004). There was no significant difference in the mean percentage of baseline seizures at 6 months; 20.2% (SD20.49) in the CKD and 27.74% (SD43.82) in the MCT KD group (p=0.73). Conclusions: We have previously demonstrated no significant difference in seizure control between the MCTKD and CKD, despite lower ketones with the MCTKD. Here we remove the potential confounder of using an enteral feeding route, and confirm no significant difference in seizure control at 6 month follow-up. Despite lower urinary ketone levels in children treated with the MCTKD compared to the CKD group, the diets were equally effective seizure therapies. Funding: Ontario Brain Institute