The Safety and Efficacy of Ketogenic Diet Therapy Among Adolescents and Adults with Refractory Epilepsy: A Systematic Review and Meta-analysis
Abstract number :
2.01
Submission category :
10. Dietary Therapies (Ketogenic, Atkins, etc.)
Year :
2024
Submission ID :
866
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Tania Farrar, MBBS, FRACP – Royal North Shore Hospital; Westmead Hospital; Sydney Children's Hospital Network; University of New South Wales
Arlene D'Silva, PhD – Sydney Children's Hospital Network; University of New South Wales
Luz Palacios-Derflingher, PhD – University of New South wales
Michael Cardamone, MBBS, FRACP – Sydney Children's Hospital Network; University of New South Wales
Michelle Farrar, MBBS, FRACP, PhD – Sydney Children's Hospital Network, University of New South wales
Rationale:
Ketogenic diet therapy (KDT) has been documented in epilepsy literature since the early 1920's but interest in it as a therapy option had largely fallen away until the 1990’s when interest in KDT for drug resistant epilepsy (DRE) management really emerged. Initially it was mostly used in children but this has changed substantially in the last 8 years with a large increase in research regarding its use in older patients with DRE and status epilepticus (SE). We have undertaken a systematic review and meta-analysis of the current literature regarding the use of KDT in adolescents and adults with DRE and SE to address the knowledge gaps around the efficacy, safety and tolerability of KDT in this patient cohort.
Methods:
A comprehensive literature search of 5 databases was undertaken. Literature that assessed the use, efficacy, safety and tolerability of KDT in patients over the age of 12 years was included. The baseline patient demographics, age, gender and type of epilepsy were extracted along with proportions of patients with >50% seizure reduction compared to baseline seizure burden and seizure freedom. Drop out rates were also reviewed as were side effects. RevMan Web was used to undertake inverse variance meta-analysis.
Results:
Critical review of 35 articles (1025 patients) looking at patients over the age of 12 years with a variety of epilepsy types was undertaken. Studies were mostly prospective or retrospective observational cohort studies with only one RCT included. We found that KDT is safe and well tolerated in this patient population with no patient’s requiring diet cessation due to safety concerns. Compliance is challenging due to the restrictive nature of KDT and the dropout rates were high (36%; 95% CI 0.28-0.44). Although only a small number of patients (16%; 95% CI 0.07-0.25) became seizure free, 41% (95% CI 0.32-0.49) of patients had a positive clinical response to KDT. KDT appears to be particularly effective in SE where 80% (95% CI 0.68-0.92) of patients had resolution of SE after KDT commencement. Patients may have benefits beyond that of seizure freedom including improved cognition, mood and quality of life.
Conclusions:
KDT appears to be a safe, tolerable and effective therapeutic option for some adolescent and adult patients with DRE. It is particularly effective in cases of SE. Despite evidence of its efficacy there remain high dropout rates in most studies. Most evidence is of low quality and larger international collaborative RCT studies are needed to establish better evidence.
Funding:
Tania Farrar is the recipient of a grant from the Australian Epilepsy Research Fund. Michelle Farrar is the recipient of an NHMRC Investigator Grant (APP1194940)
Dietary Therapies (Ketogenic, Atkins, etc.)