Do certain groups respond better to modified ketogenic diet treatments? Evaluation of adults based on imaging abnormalities, seizure type, and diet type

Objective: To evaluate response to modified ketogenic diets (MKDs) (Modified Atkins Diet (MAD) and Low Glycemic Index Diet (LGID)) within the following subgroups: abnormal imaging, epilepsy type, and diet type. Background: Although there is renewed interest in dietary treatments for epilepsy, little is known about who may best respond to ketogenic diet (KD) therapy. Design/Methods: Medical records of patients with intractable epilepsy treated with modified KDs (MAD or LGID) were retrospectively reviewed. Exclusion criteria included patients that 1) had undergone epilepsy surgery prior to diet initiation, 2) failed to follow-up at 3 months, 3) were deemed non-compliant, or 4) were Results: 40 patients met criteria with a mean age of 40 years. 67% (10/15) of those with abnormal imaging, and 56% (14/25) of those with normal imaging reported ≥50% improvement in seizure frequency. 83% (5/6) of patients with generalized epilepsy, and 56% (19/34) of patients with focal/multifocal epilepsy reported ≥50% improvement in seizure frequency. 71% (17/24) of patients on MAD, and 44% (7/16) of patients on LGID reported ≥50% improvement in seizure frequency. Conclusions: This retrospective study adds to the evidence that MKD therapy (MAD and LGID) is effective in improving seizure control in adults with refractory epilepsy, regardless of the presence of abnormal imaging. It suggests that those with generalized epilepsy respond better to MKDs than those with focal/multifocal epilepsy. Finally, we found that restrictive forms of MKD therapy (MAD) result in a better response than less restrictive forms of MKD therapy (LGID). Disclosure: Dr. Falco-Walter has nothing to disclose. Dr. Roehl has nothing to disclose. Dr. Balabanov has nothing to disclose.