Combined ketogenic diet and vagus nerve stimulation: Rational polytherapy?

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

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)77-81
Number of pages5
Issue number1
StatePublished - Jan 2007


  • Atkins
  • Children
  • Epilepsy
  • Ketogenic
  • Vagus nerve stimulation

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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