The ketogenic diet, which is high in fats and low in carbs, helped reduce the frequency of seizures and improve cognitive function in children with Dravet syndrome who are resistant to standard therapies, a small study in China found.
The study, “Prospective study of the efficacy of a ketogenic diet in 20 patients with Dravet syndrome,” was published in the journal Seizure.
Dravet patients can have multiple types of seizures throughout the evolution of their disease. Among them, brief seizures are defined as those lasting less than 5 minutes, while prolonged seizures are longer than 5 minutes, and status epilepticus is a term used to describe seizures longer than 30 minutes.
When a seizure lasts more than 5 minutes, it is likely to be prolonged further and is difficult to terminate. Intervention is usually required after 5 minutes to minimize the risk of seizures reaching status epilepticus, a phenomenon registered in up to 80 percent of Dravet patients that can lead to permanent neuronal injury and adverse outcomes.
Current strategies to manage Dravet syndrome aim to significantly reduce the frequency and duration of seizures, particularly status epilepticus, and to minimize their detrimental effects, which include intellectual disability, behavioral and psychiatric problems, and seizure-related injuries.
However, few antiepileptic treatments are effective at achieving this goal, the researchers said.
Since the 1920s, the ketogenic diet has been used to change the source of the body’s energy from carbohydrates to fats. This change promotes the use of ketone bodies — compounds produced during the metabolism of fats — as a source of energy, which is thought to have an antiepileptic effect.
Previous research supports the use of the ketogenic diet as an effective way to control Dravet-associated seizures. This diet is currently used as a therapeutic approach for refractory epilepsy in more than 70 countries, including at most epilepsy centers in the United States.
In this study, researchers investigated the efficacy and tolerability of a six-month ketogenic diet in 20 Chinese children with Dravet syndrome (12 boys and eight girls) who experienced more than two convulsions per month despite treatment.
Researchers observed the patients’ seizure activities, antiepileptic drug use, and adverse events three months before, and three and six months after, being placed on a ketogenic diet.
The diet’s efficacy was measured by comparing the frequency and duration of seizures to those observed at the start of the study.
Additionally, researchers asked at least two guardians of each child to independently evaluate changes in cognition at three and six months after beginning the ketogenic diet.
Attention, alertness, and memory were among the analyzed parameters. Improvements in cognition were only marked if noted by both guardians.
All of the children remained on the ketogenic diet for at least three months. Of the 17 who responded positively to the diet by the third month, the frequency of generalized convulsions decreased by 50-89 percent in nine patients, and 90-99 percent in two patients, the study found. Six patients had no seizures at all. The diet was ineffective or associated with worse seizures in three patients, who discontinued it.
In the same period, 55 percent of patients saw improvements in the frequency of other seizure types, too.
By the sixth month, seizures had decreased by 50-89 percent in six patients, and by 90-99 percent in one patient. Ten patients were seizure-free. The frequency of other seizure types also improved. At six months, neither generalized convulsions lasting more than 5 minutes nor status epilepticus were detected in any of the patients who responded positively.
The caregivers of 16 patients reported improvements in the children’s alertness, attention, and memory at the third and sixth months.
“Our findings support that the [ketogenic diet] is an effective therapy for [Dravet syndrome] in terms of tolerability and efficacy. The [diet] reduced the frequency of general convulsions in patients with medically intractable [Dravet syndrome],” the researchers concluded.