Optimizing Ketogenic Dietary Therapy for Children with Drug-resistant Epilepsy in a Low-income Setting: A Pilot Study on Feasibility and Clinical Outcomes
Paloma Hurtado Cuan1, Maria Alejandra Soto Blanquel2, Amado Jimenez Ruiz3, Enrique Gomez Figueroa4, Rosa Marquez Palacios5, Melissa Chavez Castillo6
1Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 2Clinical Nutrition, 3Stroke & Cerebrovascular Disease Clinic, 4Neurology, 5Pediatric Neurology, Hospital Civil de Guadalajara Fray Antonio Alcalde, 6Pediatric Epilepsy Clinic, Hospital Civil of Guadalajara Fray Antonio Alcalde
Objective:
Evaluate the feasibility and effectiveness of implementing the first Ketogenic Diet Clinic (KDC) in Mexico treating pediatric patients with drug-resistant epilepsy (DRE) in a low-resource setting.
Background:
Epilepsy affects 45.9 million people worldwide, and it is estimated that 80% of cases occur in low- and middle-income countries (LMIC) where access to antiseizure medications (ASM) is limited. This has created the need to implement strategies to reduce the treatment gap. The ketogenic diet therapy (KDT) represents an effective option, especially in cases of DRE; however, its use in LMIC has been limited and poorly documented.
Design/Methods:
A retrospective analysis was conducted on 21 pediatric patients diagnosed with DRE who initiated KDT between July 2022 and July 2024. Data were collected from the institutional database, including seizure control, ASM dose and count reduction, and nutritional interventions. Regular follow-up visits assessed the efficacy of the dietary intervention. Socioeconomic status was also evaluated using a Mexican validated survey. Statistical analysis included descriptive methods to summarize patient characteristics and longitudinal changes.
Results:
The median time from seizure onset to KDT initiation was 16 months, with the median duration on the diet being 72 weeks. Sixty percent of those attending at least three scheduled visits had a >90% reduction in seizure frequency. Sixty percent experienced a decrease in ASM doses, and 30% reduced their total ASM count. Despite not achieving complete seizure freedom, the KDT provided substantial seizure control and medication reduction.
Conclusions:
Implementing a well-structured KDC in a low-resource setting is feasible and can significantly benefit pediatric patients with DRE. The KDT led to reduced medication use, lower treatment burden, and improved seizure control in most patients, which supports the expansion of KDT for DRE in areas where access to first-line pharmacological treatments may be limited.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.