Abstracts

Rationale: We established a comprehensive ketogenic diet (KD) program at Wake Forest Medical Center to improve patient adherence and outcomes. The KD program at our institution prior to 2011 provided fragmented services. We identified quality improvement (QI) practice changes. Interventions included hiring a dedicated nutritionist, formal provider training, an inpatient protocol for a gradual initiation, aggressive management of acidosis and a team approach to outpatient management. Methods: We retrospectively reviewed the charts of 22 patients currently on the KD diet including 17 patients initiated from 2011. All children had refractory epilepsy and were treated with the classic ketogenic diet. Outcome measures analyzed were age at initiation of KD, gender, number of seizure types, adherence to the KD and seizure reduction. Results: Mean age of KD initiation was 3.9 years, 55% were male, and 40% had more than one seizure type. After initiation, 2 patients (9%) became seizure free, 7 patients (32%) had >90% reduction without being completely seizure free, 8 (36.4%) had 50 to 90% reduction, 2 (9%) had <50% reduction and 3 (13.6%) were unchanged or worse. 19 (86%) remained on the diet, 0 were lost to follow-up, 1 passed away and 2 discontinued the diet.Conclusions: Our data is suggestive of a high responder rate and low drop out. Families reported decreased seizures, decreased AEDs and increased alertness as the most positive outcomes of the diet. The results reported here are most likely due to a QI initiative that resulted in adopting a patient-centered approach to KD management, coordinated by a dedicated multidisciplinary team of providers.