Date of Award

2020

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Abstract

Objective: The objective of this selective EBM review is to determine whether or not the ketogenic diet is an effective treatment in controlling seizures in children with epilepsy.

Study Design: Review of three randomized control trials (RCTs) published in the year 2016.

Data Sources: Three RCTs were selected using Medline, PubMed, and Academic Search Premier. Studies were selected that reviewed the ketogenic diet (KD) in controlling seizures in children with epilepsy. All articles were chosen according to date of publication, relevance of topic, effect on quality of life, and patient-oriented evidence that matters (POEM).

Outcomes Measured: Seizure diaries and various scoring tests including the Hague Restrictions in Childhood Epilepsy Scale (HARCES) were utilized to assess control of seizures with number of occurrences.

Results: All three RCTs found that there were significant improvements in seizure control and frequency when using the KD as treatment in management of epilepsy in children. Study Ijiff et al. found seizures to be less severe after four months of using the KD as compared to care as usual (p=.038) based on the HARCES (Ijiff DM, Postulart D, Lambrechts, DAJE, et al. Epilepsy Behav. 2016; 60:153-157. doi: 10.1016/j.yebeh.2016.04.033). Lambrechts et al. analyzed seizure diaries revealing a significant improvement of seizure frequency among patients on the KD in comparison to the care as usual group (p=0.024) (Lambrechts, DAJE, Kinderen RJA, Vles JSH, Louw AJA, Aldenkamp AP, Majoie HJM. Acta Neurol Scand. 2017;135(2):231-239. doi: 10.1111/ane.12592). The third article, Kim et al. compared the use of KD and modified Atkin’s diet (MAD), concluding that while the KD was effective in controlling seizures, there was no significant difference between the two diets (p=0.314) (Kim DW, Kang HC, Park JC, Kim HD. Pediatrics. 2004;114(6):1627‐1630. doi: 10.1542/peds.2004-1001).

Conclusions: All three studies concluded that the ketogenic diet was effective in controlling seizures in children with epilepsy. Two found statistically significant improvement in seizure control with use of the KD when compared to care as usual, but one study found no statistical significance when comparing the KD and MAD. While the KD has been found to improve seizure control and frequency, more research is indicated to investigate other possible therapeutic diets and their outcomes.

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