Abstracts

Rationale: Ketogenic therapy (KT) has been used in the treatment of intractable epilepsy for several decades. KT is often administered with calorie restriction but whether it is needed for efficacy remains a question. Growth restriction is accepted by some centers as an anticipated and often inevitable part of KT. Our retrospective analysis of patients on KT for at least 1 year indicates a significant decrease in height z-score over time on diet (0-6 months on diet=-0.7 ± 1.4, >60 months on diet=-2.9 ± 1.6, p=<0.001). However, when patients were stratified according to time on diet, those patients who were on the diet > 60 months did not show a significant change in the height z-score over time on KT. This may be indicative that other factors besides KT may be contributing to their growth issues such as epilepsy, calorie restriction, and/or medications. We have developed evidence-based guidelines for treatment and monitoring of patients on KT and have implemented them in a prospective study conducted in the General Clinic Research Center (GCRC) at Shands/UF. Methods: We conducted a prospective analysis of height z-score in 20 patients admitted to the University of Florida KT Program for seizures. The demographics of the population were: 11 females, 9 males; 14 Caucasian, 3 African-American, 2 Hispanic, 1 Biracial; mean age of 10.1± 5.3 years. The patients were on the following AEDs: Keppra (n=9), Klonopin (n=8), Lamictal (n=5), Phenobarbital (n=5), Topomax (n=4), Primidone (n=1), Valproic Acid (n=1), Tegretol (n=1), Trileptal (n=1), Ativan (n=1), Neurontin (n=1). There were 4 patients on no AEDs and 12 patients on 2 or more AEDs. Seizure types were: Generalized (n=13), Myoclonic (n=8), Complex partial (n=7), Absence (n=4), Simple partial (n=1), and Tonic (n=1) and 9 patients had 2 or more seizure types.Results: A prospective analysis of height z-score in 20 patients stratified according to non-ambulatory versus ambulatory shows a significant difference (non-ambulatory=-2.3 ± 1.2, ambulatory=0.1 ± 0.5, p=<0.001). The mean age was 6.4 yrs ± 3.4 (n=5) for ambulatory patients and 11.3 yrs ± 5.3 (n=15) for non-ambulatory patients. A regression analysis of calories/kg body weight versus height z-score resulted in a significant positive correlation (p=0.003, R2=0.12, R=0.35), indicating that optimal calories during therapy could help alleviate potential issues with growth. Conclusions: Children treated with the KT for seizures show significant changes in height over time which may be alleviated through optimization of caloric needs. A prospective, controlled, randomized trial should be designed to determine ketogenic therapy’s direct role in growth with and without calorie restriction.