Ketogenic diet for the treatment of refractory epilepsy in a tertiary center in Northeast Brazil

*Correspondence: [e-mail].

Abstract

Background: The estimated prevalence of epilepsy is 0.5% - 1% in the global population, with 80% of these individuals living in developing countries where financial resources are generally limited. Approximately 30% of epilepsy patients have shown refractory to adequate drug treatment, requiring the use of alternative treatments such as the ketogenic diet (KD). Therefore, it is important to assess the feasibility of using this type of diet in regions and patients with limited resources.

Objective: To evaluate adherence, therapeutic response and clinical-epidemiological profile of patients with refractory epilepsy undergoing KD in a tertiary center in northeastern Brazil.

Methods: A retrospective cross-sectional study was conducted on 32 patients with refractory epilepsy who were followed from June 2020 to December 2022 at the Refractory Epilepsy Outpatient Clinic in northeastern Brazil. Variables analyzed included age, clinical response to the ketogenic diet seizure types, quantity and doses of anti-seizure medications used, route of administration, adherence and adverse effects. The study was approved by the local research ethics under the number number: 65145922.1.0000.5042.

Results: Forty-three patients were recommended for the KD, of whom 32 initiated the therapy. The majority of patients were female (59.3%), from small town (56.3%), with ages from 3 months to 17 years. Structural (40.6%) and genetic (37.5%) etiologies were the most prevalent and 34% of the sample were using gastrostomy. The frequency of epileptic seizures reduced by at least 50% in most patients (71.9%), and among them, 25% achieved complete seizure control. There was an improvement in neurodevelopmental outcomes (62.2%), reduction in the number of antiepileptic drugs used (25%), as well as in the dosage (50%) administered to the patients. Adherence to the KD was observed in a significant percentage of the sample (71.9%), and adverse effects were present in the minority of cases (28,1%).

Conclusion: The KD is a therapeutic strategy for patients with refractory epilepsy, especially for those who are not candidates for surgical treatment, particularly in children. Patients undergoing the KD showed good adherence, low frequency of adverse effects, absence of serious adverse effects, reduction in seizure frequency, and improvement in neurodevelopmental outcomes, even in a tertiary center with limited financial resources in northeastern Brazil.

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Artikel online veröffentlicht:
12. Mai 2025