Efficacy and safety of modified medium-chain triglyceride ketogenic diet in patients with drug-resistant epilepsy.

BACKGROUND

Medium-chain triglyceride ketogenic diet (MCTKD) is  previously less commonly used in China. This study was aimed to assess the efficacy and safety of the modified MCTKD in the treatment of drug-resistant epilepsy in Chinese patients.

METHODS

Patients with drug-resistant epilepsy were enrolled to receive treatment with modified MCTKD in Guangdong Sanjiu Brain Hospital during December 2020 and September 2022. The modified MCTKD contained fat that provided 50-70% of the total energy, as well as proteins and carbohydrates that provided 20-30% and 20% of energy, respectively. The fat component was composed of 20-30% medium-chain triglycerides (MCTs) and 30-40% long-chain triglycerides. The efficacy and safety of the diet were assessed at 1, 3 and 6 months.

RESULTS

A total of 123 patients aged 2.5 to 65 years, were included in this study. The response rates at 1, 3 and 6 months were 49.6%, 43.1%, and 30.9%, respectively. The seizure freedom rates at 1, 3 and 6 months were 12.2%, 10.6%, and 6.5%, respectively. The retention rates at 1, 3 and 6 months were 98.4%, 65.0% and 33.3% respectively. Side effects occurred in 21.14% of patients, which were predominantly gastrointestinal symptoms such as abdominal pain, diarrhea, vomiting, and constipation, and most of them resolved after dietary adjustments. A total of 82 patients (66.7%) discontinued the treatment with the reason of refusing to eat (8.1%), poor efficacy (35.0%), poor compliance (4.9%), and inability to follow-up (9.8%). Only 4 patients (3.3%) withdrew the diet due to side effects.

CONCLUSIONS

The modified MCTKD with MCTs providing 20-30% of energy has a good safety in patients with drug-resistant epilepsy, but its effectiveness needs to be enhanced. Further modifications of MCTKD with an optimal energy ratio are required to achieve a better efficacy and safety.