Use of medium-chain triglycerides in paediatric patients with drug-resistant epilepsy without ketogenic therapy

OBJECTIVE: This study aimed to evaluate the efficacy of a Medium Chain Triglyceride (MCT) add-on treatment in children with drug-resistant epilepsy (DRE). METHODS: We retrospectively reviewed 36 patients who received MCT add-on treatment using MCT oil (ratio C8:C10, 60:40) between June 2022 and May 2023 in our clinic. This treatment was proposed to patients before initiation of a ketogenic diet (KD), due to long waiting lists. After the completion of the MCT add-on phase patients were offered initiation of a KD. RESULTS: Overall, 66.7% of patients responded to MCT add-on treatment. The average MCT dose was 0.7 ml/kg body weight. Seizure reduction did not differ based on etiology, type of epilepsy, dietary intervention or type of feeding. No correlation was observed between seizure reduction and age at therapy, number of concomitant antiseizure medications or MCT dose. By contrast, treatment duration was positively correlated with response. After the MCT add-on phase 63.8% of patients decided to follow the proposed KD for at least 3 months. Of those, 65.2% experienced a further reduction in monthly seizures. SIGNIFICANCE: Our study shows that an MCT add-on treatment is feasible and effective in reducing seizures in paediatric patients with DRE, adding to existing evidence. Lower MCT doses might be beneficial to reduce the possibility of gastrointestinal side effects. The treatment may also serve as an introductory phase to KD, which in our cohort was associated with additional seizure reduction.