Abstracts

Rationale: The increased and prolonged use of ketogenic diets in women of childbearing age for seizure management raises questions about its safety as a gestational diet, sustained efficacy during pregnancy, and appropriate diet adjustments and monitoring during pregnancy. Methods: Herein, we report a now 38 year-old woman with intractable complex partial seizures (baseline frequency 8 seizures/month) treated over the course of 2 years with a 20 gram per day carbohydrate Modified Atkins Diet (MAD) and lamotrigine 200 mg twice a day. This combination resulted in reduction in seizure frequency to once per month. The patient became pregnant at age 36 years while on this treatment combination, and was instructed to increase net carbohydrates to 30 grams per day and continue prenatal multivitamins, 4 grams of folic acid, calcium and vitamin D supplements. Results: During pregnancy, seizures increased gradually to 1-2 times per week and lamotrigine was increased to 400 mg twice a day. Urine ketones trended down from 80 mg/dL to 15mg/dL during the second trimester. Her body mass index increased from 26.5kg/m2 to 29.7kg/m2 during pregnancy. At 39 5/7 weeks gestation, she delivered a 6 lb., 6 oz. (18th percentile) and 20.1 inches (72nd percentile) male infant. He had a left preauricular appendage and bilateral helical rim deformities with irregular borders of unknown significance that required surgical repair, but was otherwise developmentally normal at birth and 6 months. Following delivery, the patient's lamotrigine dose was reduced to 300 mg twice a day and she elected to taper off of MAD. During the taper, seizure frequency increased and she began again restricting carbohydrate intake to 35 grams per day and increasing fat intake with improvement in seizure control. Conclusions: To our knowledge, this is the first report of Modified Atkins Diet use during pregnancy. The patient had a mild increase in seizure frequency but otherwise uncomplicated pregnancy and delivery. Funding: None