Abstracts

The objectives of this study were to investigate the proportion of abnormal endoscopic lesions in intractable epilepsy children prior to KD and to reveal their relationship to patient[apos]s dietary tolerability and to know how to increase tolerability of KD in patients with abnormal endoscopic lesions., Thirty-five patients were enrolled in this study at the Epilepsy Center, Sanggye Paik Hospital, Inje University College of Medicine, from March 2002 to August 2003. Informed consents were obtained from their parents of all the patients. Gastrofiberscopy were done to all patients prior to initiation of KD. Patients with abnormal endoscopic lesions were treated with H2 receptor blocker, proton pump inhibitor, and/or prokinetics for initial 4 weeks of the KD. We observed the incidence of G-I disturbance symptoms such as nausea, vomiting, unusual irritability or cramping abdominal pain, and diet refusal for over a day in patients with abnormal endoscopic findings, as compared with the patients without such G-I lesions. We also observed the proportion of patients who showed improvement on tolerability after the active G-I medications., Of the 35 patients in this study, 18 were boys and 17 were girls. The mean ([plusmn]SD) age of the patients at the beginning of the diet was 62.9 ([plusmn]42.5) months. Various kinds of epilepsies and epileptic syndromes were subjected for this study including infantile spasm and Lennox-Gastaut syndrome. Polypharmacy with more than 4 AEDs were used in 14 patients. Sixteen patients were treated with prednisolone for more than 1 month.
Twenty patients (57%) revealed abnormal endoscopic lesions, showing 10 cases of erosive gastritis, 4 duodenitis, 3 hemorrhagic gastritis, 2 esophagitis, and 1 duodenal ulcer. The incidences of abnormal endoscopic lesions were higher by 78% (11/14) in polypharmacy group, and 81% (13/16) in steroid consumers. Symptoms from G-I disturbance such as nausea, vomiting, unusual irritability or cramping abdominal pain, and diet refusal for over a day, were complicated in 17 cases (85.0%) in patients with positive endoscopic lesions, and in 5 case (33.3%) in patients without endoscopic lesions. After the active management with G-I medications, G-I disturbing symptoms were subsided in most cases, except a patients who were discontinued KD from the intolerability., G-I disturbing symptoms were more frequently associated in patients with positive abnormal endoscopic lesions. Active management with G-I medications could increase tolerability of KD in patients treated with multiple AEDs and steroids.,