Abstracts

Ketogenic Therapy (KT) is a treatment for intractable epilepsy that is designed to mimic metabolism during starvation. Although KT has been practiced for many decades, the guidelines for practice have often been communicated orally and based on personal experience. Subjective measurements of seizure increase or decrease and of antiepileptic drug (AED) requirements are usually used. The goal of our project was to develop an evidence based KT program for treatment of epilepsy., A review of the literature on KT over the past decade was conducted and an evidence grading system was used to document current practice. A retrospective database was developed to evaluate KT provided at our center for the past decade. There are currently 184 current and non-current patients in the retrospective database of which 95 are males and 89 are females. The average age at initiation was 7.1 [plusmn] 4.9 years old and the average time on diet from non-current patients (n=133) was 17.7 [plusmn] 18.9 months. Patient tracking forms for pre-initiation, initiation, post-initiation, and termination of KT were created. Systems for quantifying and tracking seizures and medications were created to evaluate patients[apos] progress on KT. This includes Clinic Seizure Score (CSS), Daily Diary Seizure Score (DDSS), and a Medication Score (MS). The CSS is dependant upon the caregiver[apos]s recollection at clinic of seizure activity since the last clinic. The DDSS is based on daily seizure records of the caregiver and used to track the total amount of seizure activity between clinic visits. The MS allows us to evaluate both the total number and dosage of all the AEDs that a patient is taking based on their age and weight., The evidence based guidelines have been created by the University of Florida Pediatric Comprehensive Epilepsy Center. For initiation, pre-therapy records are collected and the patient comes in after an overnight fast and starts on a 1.5:1 ratio at full calories which is then increased by 0.5 every other meal for oral feeders and every day for tube feeders. During post-initiation, parents document daily ketones, specific gravity, and seizure activity as well as dietary intake for 24 hours per week. Patients are monitored using the CSS, DDSS, MS as well as the following lab parameters: comprehensive metabolic panel, complete blood count, lipid profile, serum beta-hydroxybutyrate, lactate, and acylcarnitine profile. Data from the patient tracking forms are entered in a prospective database on a weekly basis., The data obtained from the databases will allow us to evaluate and expand the evidence based KG guidelines for optimal administration and monitoring of patients throughout KT.,