Abstracts

Rationale: Epilepsy has a prevalence of approximately 1.4% in the United States. About one third of patients with epilepsy have pharmacologically refractory epilepsy. This subset of patients pose a significant challenge to the epilepsy community, with negative impact on development, presence of epilepsy co-morbidities, as well as economic burden. Both the ketogenic diet (KGD) and Vagus Nerve Stimulator (VNS) have been well studied and established effective treatments for refractory epilepsy. This study assesses the efficacy of the combined treatment using VNS and ketogenic diet.Methods: This is a retrospective chart review study from a level 4 pediatric epilepsy center assessing seizure control in patients who are treated with both VNS and KGD. Particular attention was made to the seizure control achieved with both treatments to assess if combined therapy provided improved efficacy. Seizure control was defined as a 50% or more improvement in seizures from baseline. Results: : A total of 473 patients have VNS implanted and 150 patients are treated with KGD. 13 patients had both VNS and KGD treatment. Of these patients, 10 (Group A) had KGD started after VNS had been implanted for at least 18 months. And 3 patients (Group B) had VNS implanted after being treated with KGD for at least 6 months. Response from a seizure control perspective was assessed 6 months after the introduction of the second therapy. Table 1Conclusions: The simultaneous treatment with both VNS, and KGD potentially provides synergistic anti-epileptic effect that is cumulative and seems sustainable over a period of at least 12 months after the introduction of both therapies. Further prospective large patients number study is needed.