Abstracts

Rationale: Epilepsy is one of the most common pediatric neurological disorders. A fair percentage of patients will become pharmacologically intractable, requiring further non-pharmacological methods of treatment. Ketogenic diet and vagus nerve stimulation have been well studied, safe, wide spectrum anti-epileptic methods, with proven improvement in quality of life as well as seizure burden. The objective of this study is to study the efficacy of combining a ketogenic diet, and vagus nerve stimulation, with either being initiated first in patients with pharmacologically intractable epilepsy. Methods: A retrospective chart review study in a tertiary child neurology center studying 12 patients with pharmacologically intractable epilepsy, with different epilepsy types, who are receiving a ketogenic diet, as well as having vagus nerve stimulator implanted. There were 4 males, and 8 females. With age ranging between 2.25 and 17.9 years old. These patients were devided into two groups; Group A: are patients started first on a ketogenic diet, with some seizure improvement then vagus nerve stimulator was implanted later due to continuing seizures. Group B: are patients with a vagus nerve stimulator implanted first, with some seizure improvement, then a ketogenic diet was added later due to continuing seizures. Outcome for seizure control and quality of life was studied in each group at one month, three, six, twelve, and twenty four months. Results: Out of the twelve patients, six were started on a ketogenic diet first (Group A), and six had a vagus nerve stimulator implanted first (Group B). In both groups, there was reported over 50% seizure reduction and quality of life improvement by 6 months of initiating the second treatment and that continues for long term. With no significant difference in the reported seizure control between both groups. Conclusions: Both the ketogenic diet and vagus nerve stimulator are safe, effective anti-epileptic treatments. This study did not show a significant difference in seizure control between patients on a ketogenic diet, then have a vagus nerve stimulator implanted, compared to patients who have a vagus nerve stimulator implanted first then a ketogenic diet is started.