Efficacy of 4:1 (classic) versus 2.5:1 ketogenic ratio diets in refractory epilepsy in young children: A randomized open labeled study

Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
Epilepsy research (Impact Factor: 2.02). 05/2011; 96(1-2):96-100. DOI: 10.1016/j.eplepsyres.2011.05.005
Source: PubMed


The ketogenic (lipid to non-lipid) ratio may play an important role in the efficacy and tolerability of ketogenic diets (KD). This study was planned to compare the efficacy and tolerability of 2.5:1 versus 4:1 lipid:non-lipid ratio KD in young children with refractory epilepsy.
Children aged 6 months to 5 years with refractory epilepsy were enrolled. They were randomized to receive either a 4:1 or 2.5:1 ketogenic ratio diet, which was introduced using a non-fasting protocol. Seizure frequency, biochemical profile (liver and kidney function tests, fasting lipid profile, and spot urinary calcium-creatinine ratio), and adverse effects were recorded at three months in both groups.
Thirty eight children were enrolled, 19 in each group. At three months, 11 children (58%) in the 4:1 group and 12 (63%) in the 2.5:1 group had more than 50% reduction in seizures (p=0.78). Five children (26%) in the 4:1 group and four (21%) in 2.5:1 group became seizure free. There was no significant difference in the biochemical parameters between the two groups.
2.5:1 ratio KD is possibly as effective as 4:1 KD in controlling seizures and has fewer adverse effects.

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Available from: Vykuntaraju Kammasandra Nanjundagowda, Jun 09, 2014
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    • "Though they did not compare the ratios, they reported an overall efficacy of seizure freedom in 37% and a more than 50% reduction in 81% of the patients.[28] Raju et al. conducted a randomized open-labeled study comparing the use of 2.5:1 versus the classic 4:1 ketogenic ratio diets in young children with refractory epilepsy.[41] They found comparable efficacy and tolerability of the two diets. "
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