Who are the super responders to the ketogenic diet

Introduction The ketogenic diet (KD) is mainly used in pharmaco-resistant epilepsy. However, some seem to respond dramatically to the KD while others take several months to years to have complete cessation of the seizures. Methods A retrospective study was done of all those who responded with complete cessation of seizures in less than four weeks (super responders) in all our patients since 1996. . We looked at the impact of age, seizure type, seizure syndrome, duration of seizures prior to institution of the KD and keto ratio. Results Of a total of 205 patients (ages from 4 months to 57 years), 11 patients were super-responders.  Of these 8 patients had symptomatic epileptic encephalopathy, 2 had localization related epilepsy with no lesion and 1 had localization related epilepsy with lesion. Except for two, the rest (9) had their first seizure before the age of one year. KD was begun between 7 -61 months after the onset of seizures (mean 25.2 months) while in delayed responders the average was 74.9 months. The keto ratio was less than 2:1 in four, in four it was between 2:1 and 3:1 and in three it was between 3:1 and 4:1. Conclusion Super responders are usually younger in age and those put on KD earlier. Epileptic encephalopathy seems to respond better. Individual keto ratio is not significant. Most other authors too have found the same results.