Abstracts

Rationale: Quite often, patients who receive the ketogenic diet(KD) are physically and intellectually impaired and many require enteral feedings. It is unclear if enteral feeds, which are not as dependent on multiple variables compared to oral feedings, are advantageous to better seizure control. We reviewed our data base to determine if there s an advantage in seizure control and compliance by feeding the patient on the KD enterally and orally.Methods: Patients placed on the KD or modified Atkins Diet (MAD) included 45 active patients and 26 inactive patients since January 2011. 36 of the patients were managed on the 3:1 KD ratio and greater. 23 patients are fed enterally. 13 patients are fed orally. Nine patients actively followed the MAD. There are a total of 30 patients who have discontinued the diet. Reasons for discontinuation varied greatly. 12 patients followed the KD (3:1 or greater) orally; 11 were managed enterally, and 7 followed the MAD.Results: Out of the 45 current patients actively following either the KD or MAD, 51% of the patients are fed via GT. Two enterally fed patients have been on the diet <2 weeks and response is not yet established. Two patients have not experienced a reduction in seizures; however, have improved neurocognition. The remaining 19 GT fed patients, are exhibiting favorable response to KD. Twelve established patients or 29% of the total, managed on the oral KD >3:1 are showing good response of 100%. Response is pending for a new oral initiation. Last, the MAD patient population is currently at 9 patients or 20% of the total patients. 33% of those patients are reported to have poor tolerance to the diet and poor control of their seizures. Thirty KD patients from January 2011 to May 2013 are inactive. The effect of the GT fed diet fluctuated; however, 55% of the patients exhibited good response throughout the duration of the diet. Twelve patients consumed the diet orally and also experienced a varied response. There were several indications for changing the status from active to inactive. Of the twelve who consumed PO, 67% were considered to have an improved response. The MAD diet had 7 patients who tried the diet. Two patients had surgical interventions. The remainder stopped due to poor compliance and lack of response-71% of the MAD group. Conclusions: 45 of the 71 or 63% of the active group have both tolerated and continue the diet. The active KD patients fed enterally & orally fed kids both showed improvement in seizure control: 75% enteral vs. 84% PO and the inactive group also showed improvement in seizure control: 55% vs. 67%. The inactive PO cases had a positive response but discontinued the diet due to various reasons. The active MAD patients experienced a 67% favorable response to the diet. All of the patients, who are currently not responding to MAD, have attempted the KD without success. There were 7 total inactive MAD cases. 2 patients were cured surgically and the remaining 5 were varied due to compliance issues and decreased response.