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Ketogenic Diet Effective for New-Onset Infantile Spasms Before Drug Therapy NEW YORK -- September 09, 2008 -- Use of the ketogenic diet for new-onset infantile spasms is an effective treatment for the condition before the initiation of drugs, according to a study in the September issue of Epilepsia. "We decided to review our experience at Johns Hopkins using the ketogenic diet to treat infantile spasms before medications were tried and compare this to our use of ACTH [adrenocorticotropic hormone] over the same time period," said lead author Eric Kossoff, MD, Johns Hopkins Hospital, Baltimore, Maryland. "We knew that the ketogenic diet worked well for difficult-to-control infantile spasms, so we thought it would also be effective earlier." The authors hypothesised that the ketogenic diet, previously reported as beneficial for intractable infantile spasms, would have similar efficacy but better tolerability compared with ACTH when used as first-line therapy. They conducted a retrospective chart review of all infants started on the ketogenic diet (n = 13) and high-dose ACTH (n = 20) for new-onset infantile spasms at Johns Hopkins Hospital since 1996. Of the Infants on the ketogenic diet, 8 out of 13 (62%) were spasm-free within 1 month, compared with 18 out of 20 (90%) treated initially with ACTH (P = .06). When the treatments were effective, the median time to spasm freedom was similar between infants treated with ACTH and the ketogenic diet (4.0 vs 6.5 days, P = .18). Those treated with ACTH were more likely to have a normal EEG at 1 month (53% vs 9%, P = .02); however, use of the ketogenic diet led to EEG normalisation within 2 to 5 months in all 8 infants who became spasm-free. Only 1 out of 8 had recurring spasms, and that infant was controlled again with the addition of topiramate to the diet. Side effects and recurrence rate were fewer in infants on the ketogenic diet compared with ACTH. In the 5 patients in which the diet did not work, ACTH was started immediately and worked quickly in 4 of the 5 infants. The researchers hope this novel use of the ketogenic diet may be the first step in finding another treatment to control new-onset infantile spasms. SOURCE: Wiley-Blackwell E-mail this page to a friend or colleague! To print, use this version