Abstracts

Rationale: Epileptic encephalopathy with continuous spike and wave discharge (CSWS) is an age related and often times self-limited disorder characterized by epilepsy with neuropsychological impairment and continuous spike and wave discharge in sleep. Numerous therapies have been researched and trialed in recent years including high dose benzodiazepines, anticonvulsants, and steroids. There is limited data regarding epilepsy dietary therapies in the treatment of CSWS.Methods: We performed a retrospective program evaluation of children treated with an Epilepsy Diet at Children’s Hospital Colorado between Feb. 2011 and Dec 2014. Our objective was to describe the EEG and cognitive outcomes of children treated with the ketogenic diet with documented elevated ketones and increased interictal spike (IIS) activity during sleep. Inclusion criteria: trialed any dietary therapy with increased serum ketones, IIS in sleep (>75%), perceived cognitive delay and/or regression. The electronic medical record was reviewed and the data was extracted from clinic notes. EEG reports were reviewed for spike-wave index before and after initiation of dietary therapy. The level of ketosis was assessed around the time of their follow-up EEG. Parental report of the effect on seizures and cognition was evaluated. It was our practice to not make AED changes while initiating the ketogenic diet and in the introduction phase.Results: Five patients on the ketogenic diet were identified as having increased CSWS. All had symptomatic epilepsy with abnormal MRI’s. All patients with follow-up data showed no improvement in their IIS on EEG following initiation of dietary therapy with documented established ketosis. Upon review of each patient’s history, we discovered that continuation of dietary therapy was infrequent. Only one out of the five patients chose to continue dietary therapy due the perceived benefit to cognitive skills. Three of the five stopped due to no improvement on EEG and one stopped the diet on their own accord because of no perceived benefits. Additionally, two out of the five patients reported an increase in clinical seizures despite adequate ketosis.Conclusions: Based on the patients of ours that we reviewed, results suggest that dietary therapy to treat increased spike activity during sleep is of limited benefit. Our project is limited by the number of participants and we would support research on a larger number of patients with IIS during sleep. We would also encourage research comparing SWI reduction with the modified Atkins diet vs. the Ketogenic diet.