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Frank Lefevre*, and Naomi Aronson
From the * Division of General Internal Medicine, Northwestern University Medical School, and Blue Cross and Blue Shield Association Technology Evaluation Center, Chicago, Illinois.
Objectives: To systematically review and synthesize the available evidence on the efficacy of the ketogenic diet in reducing seizure frequency for children with refractory epilepsy.
Data Sources: Medline searches were performed using the keywords epilepsy/therapy, dietary therapy, and epilepsy, and the text word ketogenic diet. The Cochrane Library of clinical trials was searched using the term ketogenic diet. Bibliographies of recent review articles and relevant primary research reports, as well as Current Contents were reviewed for additional relevant citations.
Study Selection: Studies were selected for inclusion in the review that reported the reduction of seizure frequency following treatment with the ketogenic diet in children with refractory epilepsy. The outcome measures used were the percentage of patients with: 1) complete elimination of seizures, 2) >90% reduction in seizures, and 3) >50% reduction in seizures.
Results: The evidence consists entirely of uncontrolled studies. Of 11
studies identified for this review, 9 are retrospective series of patients from
a single institution. Two studies are prospective, 1 of which is a multicenter
trial. The results of these studies are consistent in showing that some children
benefit from the ketogenic diet, demonstrated by a significant reduction in
seizure frequency. Estimates of the rates of improvement by combined analysis
(confidence profile method) are complete cessation of all seizures in 16% of
children (95% confidence interval [CI]: 11.0-21.7); a greater than 90% reduction
in seizures in 32% (95% CI: 25.3-39.8); and a greater than 50% reduction in
seizures in 56% (95% CI: 41.2-69.7). It is unlikely that this degree of benefit
can result from a placebo response and/or spontaneous remission.
Conclusions: Although controlled trials are lacking, the evidence is
sufficient to determine that the ketogenic diet is efficacious in reducing
seizure frequency in children with refractory epilepsy.
Key words: ketogenic diet, refractory epilepsy, children.
(Pediatrics. 2000;105:e46)