Does the Ketogenic Diet Prevent Relapse in Infantile Spasms?

absence seizure EEG
absence seizure EEG
The classic ketogenic diet may not have a significant impact on preventing s occurrence in patients with infantile spasms of unknown etiology.
The following article is part of conference coverage from the American Epilepsy Society’s Annual Meeting in New Orleans, LA. The Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AES 2018.

NEW ORLEANS — Adopting the classic ketogenic diet resulted in the prevention of infantile spasms relapse in patients with focal-structural and genetic etiologies but did not significantly prevent the occurrence of other seizure types in this patient population, according to study data presented at the 72nd Annual Meeting of the American Epilepsy Society, held November 30-December 4, 2018.

For patients with infantile spasms, first-line treatments include vigabatrin and adrenocorticotropic hormone (ACTH). Infantile spasms and other seizure types are commonly refractory to pharmacologic and surgical therapies for those with infantile spasms of focal-structural and genetic causes. The ketogenic diet has been proven to lower seizure occurrences in patients with intractable epilepsy, as an adjunct to other pharmacologic therapies.

Researchers from the Ann & Robert H. Lurie Children’s Hospital of Chicago assessed the efficacy of the classic ketogenic diet in preventing infantile spasms relapse and seizure occurrence by conducting a retrospective chart review.

Included patients (N=49) were categorized as either having started or not started the ketogenic diet; epilepsy etiology was categorized as either known etiology (focal-structural or genetic) or unknown etiology.

A statistically significant reduction in spasm relapse was seen in patients with known etiology who were started on the classic ketogenic diet (Chi-square 6.41; P <.05) vs patients with known etiology that were not started on the classic ketogenic diet (no relapse: 17 vs 8 patients). A relapse was seen in 6 patients in the non-ketogenic diet group vs 1 patient in the ketogenic diet group.

No statistically significant reduction, however, was seen in rates of other seizure types for patients with infantile spasms of known or unknown etiology, whether or not they were on the ketogenic diet.

The authors concluded that although the ketogenic diet may prevent relapse of infantile spasms in patients with known etiology, they will still need to undergo further monitoring for other seizure types. “The classic [ketogenic diet] had no significant impact on preventing relapse or seizure occurrence in patients with [infantile spasms] of unknown etiology. However, this population is less likely to have [infantile spasms] relapse or seizure occurrence overall,” they added.

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Wolak J, Blackford R, Lowman W, et al. Ketogenic diet prevents relapse in infantile spasms with structural and genetic etiology. Presented at: 72nd Annual Meeting of the American Epilepsy Society; November 30-December 4, 2018; New Orleans, LA. Poster 2.300.