Medium-chain triglyceride ketogenic diet for drug-resistant epilepsy in Taiwan : A prospective study in a single center

Objective: This study aimed to determine the efficacy of a medium-chain triglyceride ketogenic diet on patients with drug-resistant epilepsy over a period of 1 year and 8 months. Methods: Patients with refractory epilepsy on a medium-chain triglyceride ketogenic diet were prospectively enrolled. Their clinical condition and the effectiveness of the ketogenic diet were followed-up every month for 1 year. Adverse events and the reasons for discontinuing the diet were recorded. Results: Fifty-three patients (27 males and 26 females) were enrolled. At the end of the study, 21 patients remained on the diet, 14 of whom were followed-up for 1 year. Among the 53 patients, 22.6% had a more than 50% reduction in seizure frequency, and 16.9% became seizure-free. Conclusions: After a 1-year follow-up, the use of a medium-chain triglyceride ketogenic diet for patients with drug-resistant epilepsy was found to be a safe and effective therapy, and may be considered to bean alternative for patients with difficult-to-control seizures in children as well as young adults. Neurology Asia 2016; 21(4) : 341 – 347 Address correspondence to: Kuang-Lin Lin, Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung Children’s Hospital, No.5, Fu-shin St., Kwei-shan, Taoyuan, 33305, Taiwan. Tel: +886-3-328-1200 ext. 8200, E-mail: lincgh@cgmh.org.tw INTRODUCTION The ketogenic diet is a high-fat, low-carbohydrate, adequate-protein diet developed in the 1920s for the management of drug-resistant epilepsy. The classic ketogenic diet severely restricts calories to 85-90% of the estimated daily requirement with reduced fluid intake. The prescription of the classic diet includes a typical 4:1 ratio of fat to carbohydrates and protein combined, which can be lowered to 3:1 or 2:1 for infants, adolescents, and/or patients who require higher protein and carbohydrate content. In this diet, fat is provided by long-chain triglycerides and protein is kept to the minimum requirement for growth, with carbohydrates being very restricted. However, under such conditions, children frequently feel hungry and thus may not accept the diet. Difficulties in changing their lifestyle to adapt to the diet have been reported, especially for children and parents in Asia because rice is often the major component of the daily diet, and sharing dishes is a common practice when having meals. The medium-chain triglyceride (MCT) ketogenic diet was introduced by Huttenlocher in 1971. A MCT ketogenic diet yields more ketones per kilocalorie of energy than long-chain fatty acids, which are absorbed more efficiently and are carried directly to the liver in the portalblood. Therefore, the increased ketogenic potential yield means that less total fat is needed in the MCT ketogenic diet, allowing for more carbohydrate and protein components. Thus, a MCT ketogenic diet can provide more dietary options than the classic diet, making it more palatable and more suitable for Asian children. As patients are able to consume a wider variety and greater quantity of food with a MCT ketogenic diet, children have better growth and require fewer micronutrient supplements compared to the classic ketogenic Neurology Asia December 2016 342 diet. In addition, the efficacy of seizure control with a MCT ketogenic diet is generally equivalent to a classic ketogenic diet, and is used in the United Kingdom and Canada. One randomized trial on classic and MCT ketogenic diet treatment involving 145 children with drug-resistant epilepsy reported no significant differences between the diets in the number achieving a >50% and >90% reduction in seizures, or a reduction in the dose of antiepileptic drugs after 3 months. The aim of this study was to evaluate the efficacy and tolerability of a MCT ketogenic diet in patients with drug-resistant epilepsy in Taiwan.