Abstracts

Rationale: The ketogenic (KETO) and modified Atkins (MAD) diets have been used as effective ways to treat refractory epilepsy for years with initiation in IP (inpatient) and OP (outpatient) settings. Our aim was to assess if communications from patient families in the first month of diet initiation impact patient outcomes and laboratory values

Methods: We performed a retrospective analysis of 157 patients who started ketogenic diet 2007 - 2022. We counted the number of “exchanges” occurring within the first month of diet initiation. We documented the setting of initiation (IP/OP), duration on diet, presence of a gastrostomy tube, the diet type (KETO vs. MAD), total length on diet, bicarbonate levels and ketone levels. We compared differences between groups using either Fisher’s exact tests for categorical variables or Wilcoxon rank sum tests for continuous variables. Spearman correlations were assessed when both variables being compared were continuous or ordinal. All studies were approved by COMIRB (#17-0187)

Results: Exchanges were higher for patients on KETO (median IQR 7 (4-12.5) than MAD (median IQR 3 (1-5) (p=0.001). There was no association between exchanges and the setting of initiation (p=0.289) or whether the patient had a gastrostomy tube (p=0.408). There was a significant correlation between total length of time on diet and lower exchanges [rho (95%CI) -0.28 (-0.43, -0.12)]. The number of exchanges was not related to age of the child (p=0.152), bicarbonate level (p=0.884) or ketones levels (0.148)

Conclusions: Families reached out more when children were initiated on KETO as compared to MAD. Families that remained on diet longer, reached out less in the first month of diet therapy. The number of exchanges does not correlate with bicarbonate, ketone levels or presence of a Gastrostomy tube.

Funding: Neurologic Institute- Childrens Hospital Neurology