Abstracts

Rationale: Drug resistant epilepsy (DRE) poses a challenge in the epilepsy community. According to different statistics, about 35% of patients with epilepsy will have drug resistance epilepsy. In those patients, quality of life improvement is one of the main goals. With different non-pharmacological treatments playing a role in controlling seizures, and improving quality of life, some have synergistic effect. Ketogenic diet (KD), and Vagus Nerve Stimulator (VNS) both have been shown to be effective, well tolerated treatment modalities in patients with DRE. This data aims to highlight the synergistic effect of combining both treatments. Methods: Using an IRB approved prospective data for patients using ketogenic diet for treatment of DRE, a cohort of patients who also have VNS therapy were studied to assess quality of life improvement through family questionnaires about the children's academic performance, sleep quality, alertness, and overall mood was conducted, to assess timing and sustainability of quality of life (QOL) improvement. Also efficacy and tolerability of the combined treatment, as well as sustainability of efficacy was studied where seizure frequency and side effects data were collected in 3 months increments after a baseline analysis of seizure frequency and quality of life. With seizure control categorized to no change, < 50%, >50%, >90% seizure improvement and seizure free. Results: Out of 225 patients on the ketogenic diet, 31 patients have combined therapy with VNS (either VNS or KD initiated before the other) Age ranged from 3 to 18 years, with 16 boys. 15 patients had VNS and KGD for over 3 years (up to 72 months). At baseline, 66.7% of patients had reported improvement in quality of life on the non-pharmacological therapy (VNS or KD only). With adding the second modality, 72.7% reported improvement in QOL at 3 months, 80% at 6 months, 91% at 12 months ,and 100% at 15 months. This effect continued in patients who continued the combination therapy even past 3 years. Seizure control is highlighted in the table below in percentage: No change < 50% >50% >90% SZ free 3 months 16.7 33.3 16.7 16.7 0 6 months 16.7 16.7 50 0 0 12 months 13 13 45 29 0 24 months 0 0 66 30 4 Conclusions: Combining Vagus Nerve Stimulator and Ketogenic diet can be an effective treatment for patients with drug resistant epilepsy. In our cohort of patients, both quality of life as well as seizure control significantly impvoed over time in a comulative effect, with sustained efficacy, tolerability as well as improvement in quality of life. Funding: None