Titel: The Ketogenic Diet versus High-dose ACTH and other treatments as second line treatment in West syndrome
ID: FV 27
Art: Abstractvortrag
Session: Freie Vorträge V

Referent: Anastasia Male-Dressler (Wien/AT)

Abstract - Text


To evaluate the efficacy and safety of the second and third treatment options after the first treatment with either the ketogenic diet (KD) or standard adrenocorticotropic hormone (ACTH) treatment in infants with West Syndrome has failed.


Methods: In a parallel-cohort randomized controlled trial (RCT), infants were randomly allocated to the KD or high-dose ACTH. Those who could not be randomized were followed in a parallel cohort (PC). Those who failed the first treatment (either not seizure free or showing a relapse) were continued in a follow-up study. Primary endpoint was to compare seizure freedom to second KD versus second ACTH treatment at last- follow-up. Secondary endpoints were responses to second AED treatments and to third AED treatments at last follow-up.



101 infants were included into the primary RCT-PC study. 32 infants were randomized into the RCT and 69 into the PC. 34% of the infants responded to the first treatment in the combined cohort of the RCT and the PC. 32% responded to the second treatment, and 30% responded to the third line treatment. In total, 62% of the infants were seizure free at last follow-up. In infants receiving KD as second treatment after ACTH (n=24), 50% were seizure free, whereas in infants receiving ACTH as second treatment after KD (n= 16), only 31% were seizure free at last follow-up. In infants receiving AED treatment as second treatment (n=25), only 12% became seizure free, whereas all children (n= 2) after epilepsy surgery after initial treatment became seizure free.  In infants receiving AED after either KD- ACTH or ACTH- KD, 36% versus 25% were seizure free at last follow-up, respectively.

Significance: The KD is at least as effective as ACTH, but significantly more effective than antiepileptic drugs in the long-term when used as a second treatment option.