NEW ORLEANS — The ketogenic diet appears to be especially effective for reducing seizures in children with myoclonic-astatic epilepsy of Doose, Linda C. Laux, M.D., reported in a poster at the annual meeting of the American Epilepsy Society.
“The diet is a particularly efficacious treatment modality for this particular epilepsy syndrome,” said Dr. Laux of Northwestern University, Chicago. “It should be considered early in the course of therapy for children with myoclonic-astatic epilepsy.”
Myoclonic-astatic epilepsy (MAE) usually begins before 5 years of age in developmentally normal children. It includes a mixture of generalized seizures including myoclonic-astatic, atonic-astatic, myoclonic, absence, generalized tonic-clonic, and tonic vibratory seizures. These seizures are often difficult to control, and cognitive outcome is variable. An EEG typically shows irregular fast spike-and-wave discharges with a monomorphic 4- to 7-Hz parasagittal rhythm.
Dr. Laux presented the results of a retrospective chart study of 28 pediatric patients who were placed on the ketogenic diet over a 2-year period. Of the group, 10 had both a clinical and an EEG-aided diagnosis of MAE, 2 had cryptogenic localized epilepsy, and 16 had symptomatic generalized epilepsy (including Lennox-Gastaut syndrome periodic spasms, diffuse encephalopathy with multifocal seizures, severe myoclonic epilepsy of infancy, and generalized epilepsy not otherwise specified).
To be included in the review, patients in the study group had to be on the diet for at least 6 months; the average duration of the diet was 12 months. The best outcomes were seen in those with MAE: Six became seizure free, one had a reduction in seizure frequency of greater than 90%, and three had reductions of 50%-90%.
Children with the other epilepsies did much worse. Among those with localized epilepsy, one became seizure free, but six had a seizure reduction of less than 50%. Among those with generalized epilepsy, two had a reduction of 50%-90% and five had a reduction of less than 50%.
Both of the children with spasms and two with localization-related epilepsy had seizure reductions of less than 50%.