COMPARATIVE STUDY BETWEEN CHILDREN WITH INTRACTABLE EPILEPSY ON KETOGENIC DIET AND INTRACTABLE EPILEPTIC CHILDREN ON MEDICATION

Elham Abdel Ghaffar 1 , Yasmin Gamal El Gendy 2 , Eman R.Abd Almonaem 3 and Sara Abdel Heady 4 . 1. Professor of PediatricFaculty of Medicine Benha University. 2. Lecturer of PediatricFaculty of Medicine Ain Shams University. 3. Lecturer of PediatricFaculty of Medicine Benha University. 4. Benha Specialized children hospital. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


Subjects and Methods:-
This is a case control prospective study which was performed on 51 cases of refractory "intractable "epilepsy with age ranging from1-36 months and mean age (1.63 ± 1.13) received anti-epileptic drugs and follow ketogenic diet (modified atkin diet) which are the cases , and 15 patients with refractory epilepsy received anti-epileptic drugs only which are the control. They were 6 males and 9 females (the cases) and the same for the control. They were collected from Outpatient clinics and pediatric departments from Ain Shams university hospital and Benha university Hospital from December 2015 till December 2016.

Statistical Analysis:-
The data were coded, entered and processed on computer using SPSS (version 18).The results were represented in tabular and diagrammatic forms then interpreted. Mean, standard deviation, range, frequency, and percentage were used as descriptive statistics.
The following test was done:  Student's-test was used to assess the statistical significance of the difference between two populations means in a study involving independent samples.  Student's paired t-test was used to assess the statistical significance of the difference between two populations means in a study involving paired samples.
P value was considered significant as the following:-* P > 0.05: Non significant * P ≤ 0.05: Significant Results:- Table (1) shows that , the frequency of convulsions before diet ranged from 2 to 40 with mean 12.4 and standard deviation 10.769 compared to the frequency of convulsions after diet ranged from 0 to 10 with mean 2.20 and standard deviation 2.95 and there was statistically significant difference between the two groups (P. value was 0.001).

Table (2)
shows the Severity according to the Chalfont score Before diet ranged from 13 to 30 with mean 20.93 and standard deviation 4.75 compared to the Severity Chalfont score After diet ranged from 0 to 24 with mean 8.53 and standard deviation 7.818 and there was statistically significant difference between the two groups (P. value was < 0.001). Table (3) shows that, there was no statistically significant difference between lipid profile of the patients before diet and after diet.

Discussion:-
Refractory epilepsy can be defined as inadequate seizure control despite appropriate medical therapy with 2 or 3 AEDs or more in maximally tolerated doses for 18 months to 2 years or adequate seizure control with unacceptable drug-related side effects (Go, and Snead 2008).
The ketogenic diet is a mainstream, non-pharmacologic therapy that was developed to reproduce the success and MAD is easier to follow, requiring no calorie or fluid restrictions, although it does limit carbohydrate intake to around 15 g per day. Allowed breakfast foods include high-fat meats such as bacon, sausage and ham, as well as eggs and cheese. Low-carbohydrates breads may be allowed in small amounts, as long as the total carbohydrate intake remains within the prescribed levels (Freeman et al.,2007). Also, MAD induces a state of ketosis by providing a high fat content and few carbohydrates, so it may control seizures by a mechanism similar to that of the KD (Stafstrom, 2004).

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This study showed that, the frequency of convulsions before diet ranged from 2 to 40 with mean 12.4 and standard deviation 10.769 compared to the frequency of convulsions after diet ranged from 0 to 10 with mean 2.20 and standard deviation 2.95 and there was statistically significant difference between the two groups (P. value was 0.001). This study showed that, the Severity Chalfont score Before diet ranged from 13 to 30 with mean 20.93 and standard deviation 4.75 compared to the Severity Chalfont score After diet ranged from 0 to 24 with mean 8.53 and standard deviation 7.818 and there was statistically significant difference between the two groups (P. value was < 0.001).

This is in agreement with
Concerning lipid profile of the patients (cholesterol, triglycerides, high density lipoproteins, low density lipoproteins and very low density lipoproteins) there was no significant difference in the lipid profile before and after MAD. This is in agreement with Danish study performed by Maria et al.(2016) in which patients with refractory epilepsy received MAD showed no significant increase in free cholesterol, triglycerides, LDL, HDL and VLDL.
On the other hand, other study reported that there was elevation in "serum cholesterol levels, serum triglycerides levels, serum LDL levels and decrease in serum HDL levels"by using classic solid KD (Fenton et al.,2009).
This study showed that the mean ± standard deviation of Quality Of Life (QOL) scores was 15.71 ± 1.38 before diet which changed to 25.57 ± 3.41 after diet .This difference was statistically significant (P. value was 0.000).

Conclusion:-
Ketogenic diet (modified atkin diet " MAD") improved patients with intractable epilepsy as regard to frequency of convulsions and quality of life.