Abstracts

Rationale: The purpose of this study was to audit a newly established adult dietary therapy for epilepsy (DTE) service at a level 4 epilepsy center in Melbourne, Australia. _x000D_
Methods: All patients aged ≥18 years, referred to the epilepsy nutrition clinic at Alfred Health from July 2019 to June 2021 were included in this prospective, open-label, observational study. The clinic was conducted alongside the multidisciplinary epilepsy clinic and was held weekly in the first year and increased to twice weekly in the second year. Appointments were conducted in-person, but due to the COVID-19 pandemic, the majority of appointments occurred via video or telephone consultation. Patients were seen by the dietitian and a neurologist at each clinic appointment. _x000D_ _x000D_ Data were prospectively collected at each clinic visit. Data collected included demographics, epilepsy history, anti-seizure medications, seizure frequency, pathology, weight, diet recommendations and adverse effects._x000D_
Results: During the two-year audit period, a total of 149 patients were referred to the epilepsy nutrition clinic. Of the patients referred, 127 (85%) patients attended at least one clinic appointment. The majority of referrals were for DTE for seizure control (n=109, 86%). Patients referred for DTE had a median age of 33.0 years (IQR: 20.0-42.1 years) and 57% were female (Table 1). The median number of previously trialled anti-seizure medications (ASMs) was 6.0 (IQR: 4-7.5) and current number of ASMs prior to commencing dietary therapy was 3.0 (IQR: 2-4). _x000D_ _x000D_ After the first consultation, six patients (6%) had contraindications for commencing dietary therapy. The majority of patients were commenced on a modified  ketogenic diet (69%), followed by the low glycaemic index diet (20%)._x000D_ _x000D_ A total of 109 initial appointments and 244 review appointments occurred. At the end of the two-year audit period, n=44 (40%) remained active in the service. The main reasons for discharge were failure to attend follow up appointment (28%) or DTE not being commenced (23%). _x000D_ _x000D_ DTE was ceased due to restrictiveness (17%), ineffectiveness (14%) and unintentional weight loss (1%). At the last clinic visit 36% of patients reported a reduction, 64% reported no change and no patients reported an increase in seizure frequency score respectively. Adverse effects related to DTE were reported by 19% of patients, the majority were related to gastrointestinal symptoms (68%) and unintentional weight loss (28%).

Conclusions: There appears to be a strong demand for DTE for adults. This is one of the few studies describing the use and outcomes of adults receiving individualized DTE in the “real world” clinical setting. Utilizing a flexible approach to DTE, may improve individual patient acceptance and mitigate adverse effects. Adults with epilepsy have few contraindications to DTE. High attrition rate of DTE remains an issue. Further investigation into strategies to improve retention on dietary treatment long term is required. Development of a specific tool to assess outcomes of DTE for adults may also be beneficial. _x000D_
Funding: None