Combined use of the ketogenic diet and vagus nerve stimulation in pediatric drug‐resistant epilepsy
Abdelmoity AT, Le Pichon JB, Abdelmoity SA, Sherman AK, Hall AS, Abdelmoity AT.
Epilepsia Open. 2021 Mar; 6(1): 112–119.
https://doi.org/10.1002/epi4.12453
Vagus nerve stimulation (#VNS) therapy and ketogenic diet (#KD) are both viable #nonpharmacological treatment options for drug resistant epilepsy (#DRE) in #children. However, studies evaluating the efficacy of combining the two therapies are sparse in number. In this #retrospective study (N=33) by Abdelmoity et al. from 2021, the efficacy of combining VNS and KD was investigated in #pediatric patients with DRE, for whom either treatment option alone was deemed insufficient.
A total of 170 visits to the Children’s Mercy Kansas City hospital were recorded while the patients were undergoing both therapies, with a maximum #follow-up of 24 months. Except for the first follow-up visit, only a subset of patients attended each time point (N= 9-22 patients/follow-up at 1, 3, 6, 9, 12, 15, 18, 21 and 24 months). Out of the 170 visits, 62% (105 visits) reported a >50% reduction in seizure burden compared to either treatment option alone. The number of patients with a >50% reduction significantly increased over time and after the 15-month follow-up all patients reported some improvement in seizure frequency. Likewise, seizure freedom increased with time and stabilized at 15-20% after the 18-months follow-up.
Interestingly, the order of introduction (VNS first then KD, or vice versa) had no effect on the outcome and no significant difference was observed between focal and generalized epilepsy.
Noteworthy, patients were used as their own controls with baseline defined as seizure frequency three months prior to adding the second nonpharmacological intervention. Information about the average time with the first nonpharmacological treatment modality was lacking. Consequently, any alterations over time for a single treatment modality cannot be accounted for or ruled out. The study however suggests a #synergistic effect between KD and VNS which may lead to improved seizure control in pediatric patients.