James E. Rubenstein

A modified Atkins diet is effective for the treatment of intractable pediatric epilepsy.

Summary:  Purpose: The Atkins diet may induce ketosis as does the ketogenic diet, without restrictions on calories, fluids, protein, or need for an inpatient fast and admission. Our objective was to evaluate the efficacy and tolerability of a modified Atkins diet for intractable childhood epilepsy.

Long-term outcomes of children treated with the ketogenic diet in the past.

Purpose:  The ketogenic diet has well‐established short‐ and long‐term outcomes for children with intractable epilepsy, but only for those actively receiving it. However, no information exists about its long‐term effects years after it has been discontinued.

High-dose oral prednisolone for infantile spasms: An effective and less expensive alternative to ACTH

The ideal treatment of infantile spasms is unclear, but many studies advocate hormonal treatment. In the United States, intramuscular ACTH is most widely used, despite the problematic financial cost and side effect profile. Since September 2007, we have replaced ACTH with high-dose oral prednisolone (40-60 mg/day) according to the 2004 United Kingdom Infantile Spasms Study (UKISS). Ten of 15 (67%) infants with new-onset and previously treated infantile spasms became spasm free within 2 weeks; 4 later recurred. More children with an idiopathic etiology for infantile spasms were spasm free than were symptomatic cases (88% vs 43%, P=0.10). Spasm freedom was equivalent to our most recent 15 infants receiving ACTH, with 13 (87%) responding, P=0.16. Oral prednisolone had fewer adverse effects (53% vs 80%, P=0.10) and was less expensive (

Efficacy of the ketogenic diet in Lennox–Gastaut syndrome: a retrospective review of one institution’s experience and summary of the literature

200 vs approximately

The Outcome of Children with Intractable Seizures: A 3‐ to 6‐Year Follow‐up of 67 Children Who Remained on the Ketogenic Diet Less Than One Year

70,000) than ACTH. We now routinely recommend oral prednisolone to all families of children with infantile spasms.

Can you predict an immediate, complete, and sustained response to the ketogenic diet?

Aim  To determine the efficacy of the ketogenic diet for children with Lennox–Gastaut syndrome (LGS) at our institution and in the literature.

Experience in the use of the ketogenic diet as early therapy.

Summary:  Purpose: To determine the long‐term outcome of children with difficult‐to‐control seizures who remained on the ketogenic diet for <1 year.

The importance of parental expectations of cognitive improvement for their children with epilepsy prior to starting the ketogenic diet

Summary:  Purpose: Although the ketogenic diet has been in use for >80 years, little agreement exists as to which patients are most likely to have dramatic, sudden, and complete seizure control.

Combined ketogenic diet and vagus nerve stimulation : Rational polytherapy?

The ketogenic diet has traditionally been considered an anticonvulsant therapy of last resort, despite excellent efficacy and limited side effects. We hypothesized that the ketogenic diet would have similar results in patients with new-onset epilepsy. A retrospective study was conducted of patients started on the ketogenic diet since 1994. Thirteen of 460 (2.8%) patients were started on the ketogenic diet as early (zero or one prior anticonvulsant) therapy for seizures. Of those remaining on the diet, 60% (6 of 10) had a > 90% seizure reduction at 6 months and 100% (6 of 6) had a > 90% reduction at 12 months. Patients with infantile spasms were as likely to achieve > 50% seizure reduction at 6 months as patients with other seizure types (75% vs 60%; P = .6). The ketogenic diet can be a valuable therapy before epilepsy becomes intractable. In the 13 patients reported, efficacy without side effects was achieved similarly to that with patients with intractable epilepsy. (J Child Neurol 2005;20:31—34).

Decreased relative efficacy of the ketogenic diet for children with surgically approachable epilepsy

Although the success rates and complications of various treatment options for children with intractable epilepsy have been described, the actual expectations of parents for these treatments are less clear. Since 1998, parents at our institution have written their goals in a letter before starting their children on the ketogenic diet. One hundred consecutive letters were evaluated. The most common first goal was seizure improvement, second was anticonvulsant reduction, and third was cognitive improvement. Ninety percent requested improvement in cognition or alertness. These expectations were either met or exceeded at 6 months in 52-60% of children. Achieving or surpassing parental expectations for cognitive improvement correlated with longer diet duration (P=0.04), but meeting goals for seizure or anticonvulsant reduction did not. Cognitive improvement (P<0.001) and >90% seizure reduction (P=0.04) at 6 months positively correlated with longer eventual diet duration. Expectations for cognitive improvement need to be discussed prior to beginning the ketogenic diet.