Abstracts

Rationale: Refractory Status epilepticus (RSE) is an important neurological emergency associated with high mortality and morbidity and poses a heavy economic burden on patients and their families. Ketogenic diet (KD) has been used to treat epilepsy for 100 years. Ketogenic diet parenteral nutrition (KD-PN) has shown considerable effect in refractory epilepsy for the patients who can’t enteral feeding, but the efficacy and safety of KD-PN in RSE and SRSE, provide the comprehensive calculation formulas, application methods are not clear.

Methods: RevMan5.4 was used to perform a systematic review and a meta-analysis of the efficacy and safety of KD-PN in refractory epilepsy. Summarize parenteral nutrition (PN) guidelines, including the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), The European Society for Parenteral and Enteral Nutrition (ESPEN), The American Society for Parenteral and Enteral Nutrition (ASPEN) and The German Association for Nutritional Medicine (GANM). Optimal clinical management of children receiving KD for epilepsy. To get the calculation formulas of daily requirements such as energy, fluid, amino acids, fat emulsion (FE), glucose, and trace elements; parameters (including height, weight, age, gender, etc.); and the relevant data such as the concentration and osmotic pressure of each PN in instructions. Enter all these contents into an Excel table to form a computer algorithm.

Results: 13 studies (42 patients) were included in the systematic review. The mean(±SE) age was 5.23±4.91years (range from 0.03 to 22 years). The mean(±SE) duration KD-PN was 8.00±9.00d (range from 1 to 41d), and the mean(±SE) follow-up duration was 10.75±7.44months (range from 4 to 29 months). 29 patients (69.05%) who have an ongoing enteral KD before can maintain the efficacy (P=0.30); 13 patients (30.95%) who initiated KD for the first time can achieve the efficacy of controlling seizures (P=0.005). There was no significant correlation between the degree of ketosis and the reduction of seizures (correlation coefficient=0.138, p=0.384). 21 patients (50%) developed transient hyperlipidemia without treatment, 4 patients stopped treatment for high triglycerides or pancreatitis, and 1 patient (2.5%) died of sepsis.

Weight-based formula Resting energy expenditure (kcal/d)=20~65×weight (kg) was recommended for the patients(table 1). The Holliday Segar formula is recommended for liquid calculation. The amino acid dosage (0.6-2.0g/kg/d) was influenced of different ages and diseases. Lipids start from 1-2g/kg/d and gradually increase to the maximum 4g/kg/d. The glycerol in FE, the ethanol and propylene glycol contained in some intravenous drugs should all be considered as carbohydrates. In principle, vitamins and electrolytes should be given every day. Monitor blood sugar, blood lipids, electrolytes, etc. daily to adjust the specific dosage of each nutrient.

Conclusions: This review shows promising results for the use of KD-PN in epilepsy, but result in a low to very low overall quality of evidence. We provide a new computer-based algorithm to help doctors prescribe personalized KD-PN according to individual nutritional needs.

Funding: Please list any funding that was received in support of this abstract.: Not applicable.