What is the role of a ketogenic diet in the treatment of Lennox-Gastaut syndrome (LGS)?

Updated: Nov 09, 2018
  • Author: Koshi A Cherian, MD; Chief Editor: Amy Kao, MD  more...
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Answer

The ketogenic diet comprises a high ratio of fats (ketogenic foods) to proteins and carbohydrates (antiketogenic foods). The ratio of ketogenic to antiketogenic foods in the diet ranges from 2:1 to 4:1 or higher. In general, the benefits of the diet for people with epilepsy include fewer seizures, less drowsiness, better behavior, and need for fewer concomitant AEDs.

Based on multiple open-label and, most recently, randomized controlled studies, the ketogenic diet appears to be a useful therapy for patients with LGS. Efficacy appears greatest for atonic, myoclonic, and atypical absence seizures, but other seizure types (tonic-clonic, secondarily generalized tonic-clonic) may also respond.

In a 2008 randomized controlled trial of the ketogenic diet in children with daily seizures who had a poor response to at least 2 AEDs, 38% of the children in the diet arm had a greater than 50% reduction in seizures. Of the 145 children randomized to the ketogenic diet or control, only 14 had LGS. [37]

A blinded, crossover study of the ketogenic diet in 20 children with LGS showed a moderate reduction in parent-reported myoclonic-atonic events. Ketosis was not eliminated in the placebo arm; thus, there was no difference observed between the 2 groups regarding reduction in EEG-identified events. When seizure-free patients should be weaned from the diet is not clear. [38]


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