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The ketogenic diet, a high fat, adequate protein, low carbohydrate diet, has, during the past decade, had a resurgence of interest for the treatment of difficult-to-control seizures in children. This review traces its history, reviews its uses and side effects, and discusses possible alternatives and the diet's possible mechanisms of action. Finally, this review looks toward possible future uses of the ketogenic diet for conditions other than epilepsy., THE KETOGENIC DIET (KD), developed in the early 1920s, had fallen into disuse during the 1970s and 1980s with the rapid development of new anticonvulsant agents for epilepsy. (1) The [...]

The ketogenic diet that is used to treat children with severe seizures may increase their risk of developing heart disease by increasing blood cholesterol levels, according to a study of 141 children. A ketogenic diet contains high amounts of fat and low amounts of protein and carbohydrate. This produces substances in the body called ketones.

Objective. The objective of this study was to determine whether the ketogenic diet is safe, well-tolerated, and efficacious in the treatment of infantile spasms. Methods. During a 4-year period, 23 children with infantile spasms, aged 5 months to 2 years, were started on the ketogenic diet; 9 (39%) had symptomatic infantile spasms, and 16 (70%) had hypsarrhythmia. Children had an average prediet exposure to 3.3 anticonvulsants. Two children were enrolled before any medication had been tried. Seizure reduction was analyzed retrospectively, using parent reports and electroencephalograms (EEGs) when available. Results. At 3, 6, 9, and 12 months, 38%, 39%, 53%, and 46%, respectively, of all patients currently on the diet were >90% improved (3 were seizure-free at 12 months); 67%, 72%, 93%, and 100% were >50% improved. Fifty-six percent remained on the diet at 12 months, 46% of whom were >90% improved and 100% were >50%. Fifty percent of those with hypsarrhythmia and follow-up EEGs had EEG improvement. Fifty-seven percent had their medications reduced or discontinued by 12 months. Fifty-seven percent had improvement in development, which was correlated with seizure control. Independent factors that predicted improvement included age younger than 1 year and previous exposure to 3 or fewer anticonvulsants. No child has died, and 7 children had diet-related adverse reactions (nephrolithiasis, gastroesophageal reflux). Discussion. The ketogenic diet is a safe, well-tolerated, and possibly effective potential alternative to other therapies for infantile spasms. Pediatrics 2002;109:780-783; infantile spasms, ketogenic diet, seizures., Infantile spasms are a generalized seizure disorder characterized by clusters of sudden flexor or extensor jerks in infants who are younger than 1 year. (1,2) It is associated with both [...]

ABSTRACT. Objective. The ketogenic diet is a high-fat, low-protein, low-carbohydrate diet developed in the 1920s for the treatment of children with difficult to control seizures. Despite advances in both the [...]

Children with one of several severe neurological conditions resulting in repeated seizures may benefit from a surgical procedure involving the removal of half the brain called a hemispherectomy. Life quality measurements were evaluated in 58 children who had had hemispherectomies between 1968 and 1996. Parents and doctors considered all these operations to have been minimally to very successful in improving the patients' overall condition and reducing the number of seizures. Most operations were done on children with Rasmussen's syndrome or birth defects of the brain's physical or vessel structure. Four children died., Purpose. To report the outcomes of the 58 hemispherectomies performed at Johns Hopkins between 1968 and January 1996. Methods. Charts were reviewed of the 58 hemispherectomies performed at Johns Hopkins Medical Institutions by the Pediatric Epilepsy Group during the years 1968 to 1996. Twenty-seven operations were done for Rasmussen's syndrome, 24 operations for cortical dysplasias/hemimegalencephalies, and 7 for Sturge-Weber syndrome or other congenital vascular problems. Seizure control alone did not seem to adequately describe the outcomes of the procedure. Therefore, a score was constructed that included seizure frequency, motor disability, and intellectual handicap. This burden of illness score better described the child's handicap before and after surgery. Results. Perioperative death occurred in 4 out of 58 children. Of the 54 surviving children, 54% (29/54) are seizure-free, 24% (13/54) have nonhandicapping seizures, and 23% (12/54) have residual seizures that interfere to some extent with function. Reduction in seizures was related to the etiology of the unilateral epilepsy. Eighty-nine percent of children with Rasmussen's, 67% of those with dysplasias, and 67% of the vascular group are seizure-free, or have occasional, nonhandicapping seizures. All operations were considered by the parents and the physicians to have been successful in decreasing the burden of illness. In 44 the procedure was very successful, in 7 it was moderately successful, and in 3 it was minimally successful. Success was related to the etiology, and early surgery was preferable. Conclusion. Hemispherectomy can be a valuable procedure for relieving the burden of seizures, the burden of medication, and the general dysfunction in children with severe or progressive unilateral cortical disease. Early hemispherectomy, although increasing the hemiparesis in children with Rasmussen's syndrome, relieves the burden of constant seizures and allows the child to return to a more normal life. In children with dysplasias, early surgery can allow the resumption of more normal development. Pediatrics 1997;100:163-171; hemispherectomy, burden of illness, epilepsy surgery, quality of life., ABBREVIATIONS. CVA, cerebrovascular accident; MDQ motor developmental quotient; IQ intelligence quotient; DQ development quotient; EEG, electroencephalogram. The term hemispherectomy is used throughout the literature for several different neurosurgical procedures designed [...]

The "periodic complex" associated with subacute sclerosing leucoencephalitis is highly responsive to alterations in body temperature. At an elevation in body temperature, the complexes progressively decrease in frequency and amplitude and are eventually abolished. A lowering of the body temperature has the opposite effect. Studies of the VER and H reflex at varying temperatures suggest that the changes in the periodic complexes are mediated by alterations in synaptic activity. © 1971.

IN THE preface to the 2006 issue on brain monitoring in the neonate, White and Spitzer (1) stated that continuous electroencephalogram monitoring "will substantially enhance our understanding of neonatal neurologic [...]

A stereotype of the aftermath of a child's first afebrile seizure seems to be that the child and the panicked parents are brought to the emergency department by ambulance, an [...]

To the Editor.-- We acknowledge the publication of the article by Freeman et al entitled "Does Carnitine Administration Improve the Symptoms Attributed to Anticonvulsant Medications?: A Double-Blind, Crossover Study" in [...]

To the Editor.-- The vitriolic comments by Drs Freeman and Vining regarding various sedation/analgesia guidelines and Dr Cote's critical incident analysis of sedation-related adverse events underscore the need for the [...]