Abstracts

Rationale: Dietary therapies including the Ketogenic Diet (KD) and Modified Atkins Diet (MAD) have been proven effective but are not offered routinely to adults. We report our 1 year experience with starting an Adult Epilepsy Diet Center.Methods: A prospective, observational study of adults referred to a newly-created Adult Epilepsy Diet Center. Inclusion criteria were open-ended and included both adults with intractable epilepsy as well as less severe epilepsy of all seizure types, and starting or continuing the MAD or KD. Patients received baseline screening laboratory studies including CBC, CMP, anticonvulsant levels, and a fasting lipid panel prior to the initial visit. Adults were nearly universally started on the MAD and seen for a 1-hour individual clinic visit in the morning followed by a group 1-hour teaching session at noon. Follow-up appointments were scheduled for every 3 months and occurred in the afternoon. All patients were seen by both a neurologist and adult dietitian for education. Each Center clinic occurred monthly with approximately 3-4 adults started on the diet during each clinic.Results: Thirty-six subjects (median age 25 years at onset of diet treatment, 72% female) were consented and have been seen from August 2010-July 2011. Eight patients had already been receiving dietary treatments (4 MAD, 4 KD) at consent and had at least 50% seizure reduction beforehand; the median diet duration was 4.75 years (range: 0.5-26). Of the 28 starting dietary therapy, 19 began the MAD, 6 have not yet started or are deciding whether or not to start, and 3 chose not to begin despite the clinic visit. The median anticonvulsants tried prior to starting dietary therapy was 6 (range: 0-11) and median seizure frequency was 4 per week (range: 0.25-500). Seventeen patients that started the MAD supplied a 1-month seizure calendar, and at least moderate urinary ketosis was achieved in 13 (76%). Fourteen (82%) derived some benefit from the MAD, including 8 (47%) with >50% seizure reduction of which 4 (23%) became seizure-free. Patients who became seizure-free overall had juvenile myoclonic epilepsy (2) and localization-related epilepsy (8). At this time, the median diet duration is 7 months (range: 1 month-26 years). Most patients who have stopped the diet chose to discontinue due to inefficacy, side effects, or increase in seizure frequency, typically at 1-5 months. Reported side-effects included weight loss, alopecia, hyperlipidemia, constipation, nephrolithiasis, amenorrhea, and osteopenia.Conclusions: In the first year of existence, we have had high interest and preliminary success with a clinic-based Center for adults wishing to start or maintain dietary treatments for epilepsy. This provides an option for children on the KD who graduate from pediatric neurology ketogenic centers as well as adults starting the MAD for the first time. Our approach to plan a monthly clinic with new patients in the morning, a group teaching session at noon, and follow-ups in the afternoon was time-effective.