Abstracts

RATIONALE:We wanted to confirm our preliminary results with the classic Johns Hopkins ketogenic diet (CKD) in more patients with longer follow-up. METHODS:We initiated an additional 22 patients onto the CKD since 1998 to a total of 71 patients. Our protocol was the same as before 1998 with quantitative fine-tuning of energy substrate moieties by a full time registered dietitian, full time registered nurse, and pediatric neurologist. Hospital days for diet initiation was decreased from 4 to 3 days by eliminating concentrated sweets 2 weeks prior to admission and by initiating a low carbohydrate diet for 48 hours before admission. Daily seizure records were kept before and after diet commenced. Average diet duration was 15 months. RESULTS:Based on intention to treat, the 71 patients had the following outcomes. Seizure free in 9, reduction by 9/10 in 22, reduction by 1/2 in 12, no response in 6, not tolerated in 7 (transient hyperlipidemia or transient gastritis), and non-compliance in 15. Compliance and tolerance was determined within one month. There were no permanent complications. Of the 49 who tolerated and were compliant, 88% had a significant seizure reduction, and 63% were seizure free or had 90% reduction, significant to improve the Quality of Life. Of those who complied with and could tolerate the diet, significantly improved were 43/49 (88%) in 2000 compared with 30/34 (88%) in 1998. CONCLUSIONS:Sustained responses and similar outcomes with larger numbers and longer follow-up makes it unlikely that the diet's effect is placebo. The placebo effect diminishes over time with a maximum effect of 60% transiently for surgery. The results reported here may be due to a dedicated team of full-time personel.