Discussion
’ cognitive and functional status, drowsiness, seizures, seizure, West syndrome, myoclonic-astatic epilepsy, TG, epileptic, weight loss
DOOSE SYNDROME, TUBEROUS SCLEROSIS, MYOCLONIC-ASTATIC EPILEPSY, WEST SYNDROME, SYNDROMES, EPILEPTIC, RETT SYNDROME
Forty patients with DRE were initially enrolled in this prospective study, but only 30 patients successfully completed it. Six patients (15%) were unable to tolerate KD and were removed from the study (85% tolerability), three additional patients were excluded due to parental noncompliance and one case died during the study period. Overall reasons for dropout were mostly intolerance of the diet, AEs (mostly GI tract related), weight loss, parental unhappiness and change of mind.Meta-analysis studies have confirmed the efficacy of the KD and showed a seizure frequency reduction (SFR) of ≥50% for both the classic KD and MAD.With a median percent change of −100%, we also documented a statistically significant reduction in seizure severity based on the CSSS 3 and 6 months after the KD compared to baseline in both groups. Two RCTs reported a statistically significant decrease in seizure severity, El-Rashidy et al.The KD enhanced patients’ cognitive and functional status while also reducing seizure severity and frequency. Six months following KD, we noticed improvements in functional status and cognition, with 66.67% of patients in the MAD group and 46.67% of patients in the classic KD group displaying better attention. This is essential for DRE patients since uncontrolled seizures and the use of numerous anticonvulsants may negatively impact cognition, behavior, drowsiness, memory, and attention issues.Several studies revealed the effectiveness of KD for epileptic syndromes such as myoclonic-astatic epilepsy, Rett syndrome, West syndrome (particularly combined with tuberous sclerosis), and Dravet and Doose syndromes.Although the KD has been proven to be a successful treatment for reducing seizures in DRE patients, its wider effects on cerebral neurophysiology are less clear.KD side effects are frequently blamed for trial dropouts since they are observed in a high percentage of young patients.Lipid profile underwent frequent changes throughout the study period. However, HDL median levels did not reach the low level and the median of LDL, total cholesterol and TG measurements remained within the acceptable range till the end of the study for 24 months with a non-significant difference between classic KD and MAD. Kossoff et al., in 2006, 2007, and 2008 over the course of these investigations, observed that there was a comparable increase in total cholesterol and LDL levels, which was within the accepted value.Systematic reviews have discovered conflicting results about the KD’s effects on growth, with some indicating a favorable benefit and others indicating a negative impact.Due to their excellent response to the diet, it was possible to withdraw AEDs in 13 patients (43.33%) after the first 6 months: one AEDs in 8 patients (3 in classic KD group vs. 5 in the MAD group) and two AEDs in 5 patients (3 in classic KD group vs. 2 in the MAD group). This can be attributed to the patients’ functional status and QoL.The study’s points of strength include its prospective nature, which increased the accuracy of our data. We studied two types of KD (classic KD and MAD) commonly used for DRE to allow more options and less diet restrictions. In addition, the effectiveness of the KD regarding seizure control was not measured based solely on caregiver reports but included the EEG changes so allowing more objective evaluation and avoiding subjective errors. Along with growth tracking and documenting of the KD’s effects on growth, we also evaluated the KD’s safety for up to 24 months in terms of side effects and cardiovascular risk.