Abstracts

Rationale: Among the barriers to treatment of pediatric epilepsy in Zambia are the limited availability and irregular supply of anticonvulsant medications. Ketogenic diet (KD) therapy is an internationally utilized, well-established treatment for epilepsy; yet, it is offered in only 4 African countries due to limited clinician knowledge about the diet and lack of clinically-trained dietitians. Boston Children’s Hospital’s (BCH) Neurology department has an established global health liaison with University Teaching Hospital (UTH) in Lusaka, Zambia. Methods: The neurologist director of and a licensed dietitian from BCH’s KD Program travelled to Lusaka to conduct a pilot project to initiate 2 children on the KD with the goal of assessing feasibility. Local foods appropriate for KD were identified with the assistance of local clinic staff. The children, a 5- year-old boy with refractory epilepsy following encephalitis and a 32-month-old boy with Down Syndrome-associated refractory infantile spasms, were admitted for diet initiation starting at low ketogenic ratios of 2:1 and 1.5:1, respectively. Blood ketone and glucose levels were checked daily using a portable blood ketone monitor and a glucometer, and patients were monitored clinically for symptoms of acidosis and hypoglycemia. Both families were educated on implementing the diet at home. UTH nutritionists were trained on the basics of KD and participated in diet calculations, food preparation, and family education so that they could implement future dietary changes. Results: Both children achieved ketosis at their respective starting ketogenic ratios in less than 48 hours after initiation. Mild tachycardia and tachypnea above baseline were treated with increased fluid intake.  Neither experienced symptoms of hypoglycemia.Challenges of diet implementation included cultural attitudes toward food and baseline high carbohydrate diet, lack of reliable nutrition information for local foods, cost of high-quality animal protein foods, lack of affordable, rapid lab testing for pre-diet testing and initiation monitoring, limited availability of low-carbohydrate vitamin and mineral supplements, lack of professional interpreter services for education, and limited availability of adequate food preparation and storage facilities for ketogenic foods in the hospital.8 months after diet initiation, both children are still following the diet and are in ketosis with subsequent increases to their ketogenic ratios, supported and implemented by the local nutritionists.  The 5-year-old is seizure-free.  The 32-month-old has experienced a reduction in seizures and has made developmental gains. Conclusions: It is feasible to initiate the KD for children with epilepsy refractory to the available antiepileptic drugs who live in resource-poor regions. Nutritionists who are not clinically trained but who have an interest in learning about KD therapy can be trained to support these patients.  Challenges remain in terms of knowledge of geographically specific food information, communication and cultural competence and logistics of admission/healthcare utilization/transportation in these areas. Funding: No funding was received in support of this abstract.