Abstracts

Rationale: Ketogenic diet (KD) is particularly indicated in children with refractory epilepsy and daily seizures. Is this group of patients, epilepsy has a devastating evolution and seizure control may change neurological and developmental progress. KD may change this evolution and total seizure control or its substantial reduction may be achieved in 30 to 50% of the patients, with the possibility of decrease of the number of antiepileptic drugs and its levels, with direct cognition effects. Children usually became less hyperactive and irritable and improve in neurological development is usually present. Patients with refractory epilepsy nutritional status may be prejudiced by developmental delay and epileptic drugs ingestion, especially when using multiple drugs, with the occurrence of growth disturbance. Bertoli et al (2006) demonstrated the presence of malnutrition that was actual in 40% and chronic in 24% of children with refractory epilepsy. This work considers nutritional status and evolution of children using KD Methods: 29 children with refractory epilepsy using KD were evaluated in Ribeirão Preto Clinical Hospital. Patients were analyzed in respect to seizure control and anthropometric data (weight, high and its relation with actual age) according to Waterlow (1973). Laboratory examinations included albumin, total proteins, cholesterol and fractions, serum vitamins, blood routine counting, iron, potassium, sodium, calcium, zinc, phosphorus, creatinine, urea, glucose, magnesium, triglyceride and hepatic enzymes. Exams were performed before KD introduction and each six months or when patient interrupted KD use Results: 13/29 patients were male. Mean age of KD introduction was 6.1 years (range 1 to 15 years) and mean time use was 11 months (2 to 36 months). Epilepsy was focal symptomatic in 24.1% of children, generalized symptomatic in 65.5%, focal cryptogenic in 3.5% and generalized cryptogenic in 6.9%. Seizure reduction was achieved in 44% of the patients. Considering patients that used KD for at least one year, before KD introduction, 14.3% of patients were eutrophic and 85.7% had actual sub nutrition. At the end of follow up, 28.6% of patients were eutrophic, 42.8% had sub nutrition with high deficits and 28.6% had chronic sub nutrition. Blood examinations remained normal during the study, except for cholesterol that had an increase in the first month of KD use, with posterior normalization at six months to the end of follow-up. Conclusions: Children with refractory epilepsy to most of available antiepileptic drugs using KD had a satisfactory seizure control in 44% of cases. Anthropometric evaluation of these children showed a high proportion of mal nutrition before KD introduction, with partial recovery of nutritional status at the end of the study. This data is similar to that observed by Couch et al (1999) and Liu (2003) and divergent of that found by Willians et al (2002) that related suboptimal growth in long term follow-up of children using KD. This shows the importance of nutritional evaluation in children with epilepsy, especially when using KD