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Clinical implementation of ketogenic diet in children with drug-resistant epilepsy: Advantages, disadvantages, and difficulties

  • Author Footnotes
    1 The authors contributed equally to this work.
    Xin Tong
    Footnotes
    1 The authors contributed equally to this work.
    Affiliations
    Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China

    Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University, Chengdu, China
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  • Author Footnotes
    1 The authors contributed equally to this work.
    Yao Deng
    Footnotes
    1 The authors contributed equally to this work.
    Affiliations
    Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China

    Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University, Chengdu, China
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  • Ling Liu
    Affiliations
    Department of Rehabilitation Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
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  • Xiang Tang
    Affiliations
    Department of Rehabilitation Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
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  • Tao Yu
    Affiliations
    Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China

    Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University, Chengdu, China
    Search for articles by this author
  • Jing Gan
    Affiliations
    Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China

    Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University, Chengdu, China
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  • Qianyun Cai
    Affiliations
    Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China

    Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University, Chengdu, China
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  • Rong Luo
    Correspondence
    Corresponding author at: West China Second University Hospital, Sichuan University, No. 20, Section 3, South Renmin Road, Chengdu 610041, Sichuan, China.
    Affiliations
    Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China

    Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan University, Chengdu, China
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  • Nong Xiao
    Correspondence
    Corresponding author at: Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, YuZhong District, Chongqing, 400014, China.
    Affiliations
    Department of Rehabilitation Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
    Search for articles by this author
  • Author Footnotes
    1 The authors contributed equally to this work.

      Highlights

      • KD has been gaining ground in Southwest China.
      • KD was effective in controlling seizures, but long-term adherence was difficult.
      • Compliance problem was prominent, and some reasons for discontinuation were avoidable.
      • Enhancing food taste and patient support can help to improve the retention rate.
      • Disadvantages of KD such as negative impacts on linear growth were also observed.

      Abstract

      Purpose

      Ketogenic diet (KD) is a well-established nonpharmacologic treatment for drug-resistant epilepsy. However, although KD has a long history of clinical use, there are still many difficulties with its real-world practice. This study retrospectively described the situation of KD practice in two children's hospitals in Southwest China.

      Methods

      We reviewed and analyzed clinical data collected at the baseline, and during follow ups at 1, 3, 6, 12, 18, and 24 months. The patient retention, the efficacy, side effects of KD, and the reasons for discontinuation were focused.

      Results

      There was increasing availability of KD for children with epilepsy in Southwest China and its effectiveness in controlling seizures was reconfirmed. Nonetheless, less than half of the patients adhered to KD for one year and about 1/5 of the patients for two years. Unsatisfactory seizure control was the most common reason for discontinuation, followed by patient/caregiver preference, acute infection, and loss to follow up. Adverse effects were mostly tolerable and not the main reason for discontinuation. Meanwhile, KD showed negative impacts on linear growth, and our cohort seemed to have more infections and deaths.

      Conclusions

      Despite increasing availability and good efficacy, long-term adherence to KD was difficult. Compliance issues appeared to be prominent. Enhancing food taste and patient support can help to improve the retention rate.

      Keywords

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