| Combined ketogenic diet and vagus nerve stimulation: rational polytherapy? | |
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MedLine Citation:
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PMID: 17241211 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The concept of "rational polypharmacy" has been associated with anticonvulsant management for decades, but the term has not been applied to nonpharmacologic therapies. METHODS: We conducted a multicenter, retrospective study of children who received concurrent diet (ketogenic or modified Atkins) and vagus nerve stimulation (VNS) treatment for medically intractable epilepsy. RESULTS: Thirty children in total from six epilepsy centers were treated over a 6-yr period. The median age at the initiation of combination therapy was 10 yr (range, 4-24 yr). Sixteen (53%) received dietary therapy followed by VNS; no differences were noted between centers. After 3 months, 21 (70%) had seizure reduced by >50% over the previous single nonpharmacologic treatment, of whom 13 (62%) had improvement within the first month. A 5-min VNS off-time correlated with >90% seizure reduction (p = 0.02). The median duration of nonpharmacologic polytherapy was 12 months (range, 0.5-96 months); 17 (57%) remain on dual therapy at this time. No side effects were noted. Most patients who discontinued combination therapy did so because of a lack of efficacy rather than restrictiveness. CONCLUSIONS: In this small group, the combined use of diet and VNS appeared synergistic and yielded rapid benefits. It may be more effective with longer VNS off-times. Further prospective studies of this combination in refractory pediatric epilepsy are needed to help guide optimal use. |
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Authors:
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Eric H Kossoff; Paula L Pyzik; James E Rubenstein; A G Christina Bergqvist; Jeffrey R Buchhalter; Elizabeth J Donner; Douglas R Nordli; James W Wheless |
Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Epilepsia Volume: 48 ISSN: 0013-9580 ISO Abbreviation: Epilepsia Publication Date: 2007 Jan |
Date Detail:
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Created Date: 2007-01-23 Completed Date: 2007-03-27 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 2983306R Medline TA: Epilepsia Country: United States |
Other Details:
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Languages: eng Pagination: 77-81 Citation Subset: IM |
Affiliation:
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The Johns Hopkins Hospital, Baltimore, Maryland 21287-1000, USA. ekossoff@jhmi.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Child Child, Preschool Combined Modality Therapy Diet, Carbohydrate-Restricted Dietary Fats / administration & dosage*, metabolism* Electric Stimulation Therapy / methods* Epilepsy / diet therapy*, metabolism, therapy* Evaluation Studies as Topic Female Humans Ketosis / metabolism* Longitudinal Studies Male Retrospective Studies Treatment Outcome Vagus Nerve / physiology* |
| Chemical | |
Reg. No./Substance:
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0/Dietary Fats |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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