Ketogenic Diet and Vagus Nerve Stimulator Practices as Alternative Treatment Options in Refractory Epilepsy
Abstract number :
2.367
Submission category :
15. Practice Resources
Year :
2022
Submission ID :
2204159
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:23 AM
Authors :
Amy Tennant, MS, APRN, CPNP-PC – Ann and Robert H. Lurie Childrens Hospital of Chicago; Robyn Blackford, RD, LDN – Registered Dietician, Ann and Robert H. Lurie Childrens Hospital of Chicago; Wesley Lowman, RD, LDN – Registered Dietician, Ann and Robert H. Lurie Childrens Hospital of Chicago; Savannah Morris, MS, APRN, CPNP-PC – Advanced Practice Provider, Ann and Robert H. Lurie Childrens Hospital of Chicago; Kelly Nelson, MSN. RN, CPN – Ann and Robert H. Lurie Childrens Hospital of Chicago; Priya Tatachar, MD – Ann and Robert H. Lurie Childrens Hospital of Chicago; Breanne Fisher, MSN, APRN, CPNP-PC – Advanced Practice Provider, Epilepsy, Ann and Robert H. Lurie Childrens Hospital of Chicago
This abstract is a recipient of the Nurse and Advanced Practice Provider Travel Award
Rationale: Nearly one-third of patients diagnosed with epilepsy will become refractory. When patients fail to respond to anti-seizure medications, it is essential to consider alternative treatment options such as the ketogenic diet and surgical candidacy including vagus nerve stimulation (VNS). Both the ketogenic diet and VNS have similar responder rates, with >50% of patients with a reduction in seizures (Kossoff and Shields, 2014). We sought to examine the alternative treatment practices for patients with intractable epilepsy at a large urban pediatric institution. _x000D_
Methods: A retrospective chart review was performed to identify patients at a large urban pediatric institution who have been treated with both the ketogenic diet and VNS for intractable epilepsy over the past 10 years. Age of seizure onset, diagnosis, etiology, age of ketogenic diet initiation, and age of VNS insertion were collected.
Results: There were a total of 37 patients identified as having been treated with both VNS and the ketogenic diet (24 males [65%], 13 females [35%]). The mean age at diagnosis was 1.24 years. 24/37 (65%) had a diagnosis of Lennox-Gastaut syndrome (LGS), 6/37 (16%) had intractable focal epilepsy, 2/37 (5%) had intractable epilepsy with both generalized and focal features, 2/37 (5%) had myoclonic astatic epilepsy (MAE), 2/37 (5%) had Dravet, and 1/37 (3%) had otherwise intractable generalized epilepsy. Etiology was as follows: 14/37 (38%) genetic, 9/37 (24%) unknown, 5/37 (14%) presumed lesional, 4/37 (11%) Hypoxic ischemic encephalopathy, 2/37 (5%) trauma, 2/37 (5%) congenital malformation/injury. 35/37 (95%) initiated the ketogenic diet prior to VNS insertion. The average age of ketogenic diet initiation was 4.8 years and the average age of VNS insertion was 8.4 years. _x000D_
Conclusions: In our retrospective chart review of patients treated with both the ketogenic diet and VNS, providers at our institution typically treat with the ketogenic diet before inserting a VNS. Parents of young children are often not ready to consider surgery as well as the fact that VNS is FDA approved for children four and older (Kossoff, 2013). Some studies have sought to evaluate combined therapy and suggest that the ketogenic diet and VNS had a synergistic effect (Kossoff et al., 2007). This presents an opportunity to further study their relationship and impact on seizure burden.
Funding: Not applicable
Practice Resources